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      The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

      review-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 1 , 7 , 15 , 16 , 7 , 17 , 18 , 19 , 13 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 7 , 44 , 45 , 46 , 47 , 48 , 23 , 49 , 50 , 51 , 52 , 53 , 40 , 54 , 55 , 64 , 28 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Intra-abdominal infections, Sepsis, Peritonitis, Antibiotics

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          Abstract

          Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide.

          The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important.

          In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs.

          The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

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          Most cited references265

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          The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria.

          From early this decade, Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases (KPC) were reported in the USA and subsequently worldwide. These KPC-producing bacteria are predominantly involved in nosocomial and systemic infections; although they are mostly Enterobacteriaceae, they can also be, rarely, Pseudomonas aeruginosa isolates. KPC beta lactamases (KPC-1 to KPC-7) confer decreased susceptibility or resistance to virtually all beta lactams. Carbapenems (imipenem, meropenem, and ertapenem) may thus become inefficient for treating enterobacterial infections with KPC-producing bacteria, which are, in addition, resistant to many other non-beta-lactam molecules, leaving few available therapeutic options. Detection of KPC-producing bacteria may be difficult based on routine antibiotic susceptibility testing. It is therefore crucial to implement efficient infection control measures to limit the spread of these pathogens.
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            Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.

            Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.
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              A practical score for the early diagnosis of acute appendicitis.

              We conducted a retrospective study of 305 patients hospitalized with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analyzed for specificity, sensitivity, predictive value, and joint probability. The total joint probability, the sum of a true-positive and a true-negative result, was chosen as a diagnostic weight indicative of the accuracy of the test. Eight predictive factors were found to be useful in making the diagnosis of acute appendicitis. Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain. Based on this weight, we devised a practical diagnostic score that may help in interpreting the confusing picture of acute appendicitis.
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                Author and article information

                Contributors
                m.sartelli@virgilio.it
                alainchichom@yahoo.com
                labricciosafrancesco@gmail.com
                Hardcastle@ukzn.ac.za
                fabuzidan@uaeu.ac.ae
                adesunkanmi@yahoo.com
                lansaloni@asst-pg23.it
                rbalam@hadassah.org.il
                zsolt.balogh@hnehealth.nsw.gov.au
                beltran_01@yahoo.com
                o_ben-ishay@rambam.health.gov.il
                Wbiffl@queens.org
                arianna.birindelli@gmail.com
                miguelangel.cainzos@usc.es
                catalinigb@gmail.com
                marco.ceresoli89@gmail.com
                asricj@yahoo.com
                ochiara@yahoo.com
                federico.coccolini@gmail.com
                rcoimbra@ucsd.edu
                francescocortese@gmail.com
                zdemetr@yahoo.com
                salo75@inwind.it
                jdiaz@umm.edu
                egiev50@gmail.com
                paula.ferrada@vcuhealth.org
                fragagp2008@gmail.com
                wghnnam@gmail.com
                jakii@yuhs.ac
                caxiaogomes@gmail.com
                Andreas.Hecker@chiru.med.uni-giessen.de
                t.herzog@klinikum-bochum.de
                erythrokim@paik.ac.kr
                Kenji.Inaba@med.usc.edu
                kararda@yahoo.com
                alekara@sbb.rs
                jeffrykashuk@gmail.com
                docvladimir@yandex.ru
                Andrew.Kirkpatrick@albertahealthservices.ca
                y_kluger@rambam.health.gov.il
                kkoike@kuhp.kyoto-u.ac.jp
                victorywkong@yahoo.com
                Ari.Leppaniemi@hus.fi
                gmmachain@yahoo.com
                ronmaier@uw.edu
                drsanjay.marwah@gmail.com
                michaelm500@yahoo.com
                giulia.montori@gmail.com
                Ernest.Moore@dhha.org
                negoiionut@gmail.com
                tunde_olaoye_dr@yahoo.com
                akomari@just.edu.jo
                ordonezcarlosa@gmail.com
                drbrunompereira@gmail.com
                gersonapj@gmail.com
                aslimnicagp@gmail.com
                tcr@hotlink.com.br
                bsakakushev@gmail.com
                drnori@kuhp.kyoto-u.ac.jp
                hhaassll@gmail.com
                vgshelat@rediffmail.com
                ksoreide@me.com
                w.uhl@klinikum-bochum.de
                Jan.Ulrych@vfn.cz
                Harry.vanGoor@radboudumc.nl
                GVELMAHOS@mgh.harvard.edu
                traumayuan@gmail.com
                imtazwani@gmail.com
                dietergweber@gmail.com
                skzach@yahoo.com
                faustocatena@gmail.com
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                10 July 2017
                10 July 2017
                2017
                : 12
                : 29
                Affiliations
                [1 ]Department of Surgery, Macerata Hospital, Macerata, Italy
                [2 ]Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
                [3 ]ISNI 0000 0001 1017 3210, GRID grid.7010.6, Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, , Università Politecnica delle Marche, ; Ancona, Italy
                [4 ]Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
                [5 ]ISNI 0000 0001 2193 6666, GRID grid.43519.3a, Department of Surgery, College of Medicine and Health Sciences, , UAE University, ; Al-Ain, United Arab Emirates
                [6 ]ISNI 0000 0001 2183 9444, GRID grid.10824.3f, Department of Surgery, College of Health Sciences, , Obafemi Awolowo University, ; Ile-Ife, Nigeria
                [7 ]ISNI 0000 0004 1757 8431, GRID grid.460094.f, General Surgery Department, , Papa Giovanni XXIII Hospital, ; Bergamo, Italy
                [8 ]ISNI 0000 0001 2221 2926, GRID grid.17788.31, Trauma and Acute Care Surgery Unit, , Hadassah Hebrew University Medical Center, ; Jerusalem, Israel
                [9 ]ISNI 0000 0004 0577 6676, GRID grid.414724.0, Department of Traumatology, , John Hunter Hospital and University of Newcastle, ; Newcastle, New South Wales Australia
                [10 ]Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
                [11 ]ISNI 0000 0000 9950 8111, GRID grid.413731.3, Department of General Surgery, , Rambam Health Care Campus, ; Haifa, Israel
                [12 ]ISNI 0000 0001 1482 1895, GRID grid.162346.4, Acute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, , University of Hawai‘i, ; Honolulu, USA
                [13 ]ISNI 0000 0004 1759 7093, GRID grid.416290.8, Department of Surgery, , Maggiore Hospital, ; Bologna, Italy
                [14 ]ISNI 0000 0000 8816 6945, GRID grid.411048.8, Department of Surgery, , Hospital Clínico Universitario, ; Santiago de Compostela, Spain
                [15 ]Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
                [16 ]GRID grid.416200.1, Emergency Department, , Niguarda Ca’ Granda Hospital, ; Milan, Italy
                [17 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Department of Surgery, , UC San Diego Medical Center, ; San Diego, USA
                [18 ]Emergency Surgery Unit, San Filippo Neri’s Hospital, Rome, Italy
                [19 ]ISNI 0000 0004 0428 8304, GRID grid.412274.6, Department of Surgery, , Tbilisi State Medical University, Kipshidze Central University Hospital, ; T’bilisi, Georgia
                [20 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, Shock Trauma Center, , University of Maryland School of Medicine, ; Baltimore, USA
                [21 ]ISNI 0000 0000 9559 0613, GRID grid.78028.35, Department of Surgery, , Pirogov Russian National Research Medical University, ; Moscow, Russian Federation
                [22 ]ISNI 0000 0004 0458 8737, GRID grid.224260.0, Department of Surgery, , Virginia Commonwealth University, ; Richmond, VA USA
                [23 ]ISNI 0000 0001 0723 2494, GRID grid.411087.b, Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, , University of Campinas (Unicamp), ; Campinas, SP Brazil
                [24 ]ISNI 0000000103426662, GRID grid.10251.37, Department of General Surgery, Mansoura Faculty of Medicine, , Mansoura University, ; Mansoura, Egypt
                [25 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Department of Surgery, , Yonsei University College of Medicine, ; Seoul, Republic of Korea
                [26 ]Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
                [27 ]ISNI 0000 0000 8584 9230, GRID grid.411067.5, Department of General and Thoracic Surgery, , University Hospital Giessen, ; Giessen, Germany
                [28 ]ISNI 0000 0004 0490 981X, GRID grid.5570.7, Department of Surgery, St. Josef Hospital, , Ruhr University Bochum, ; Bochum, Germany
                [29 ]ISNI 0000 0004 0470 5112, GRID grid.411612.1, Department of Surgery, Ilsan Paik Hospital, , Inje University College of Medicine, ; Goyang, Republic of Korea
                [30 ]ISNI 0000 0001 2156 6853, GRID grid.42505.36, Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, , University of Southern California, ; Los Angeles, CA USA
                [31 ]ISNI 0000 0001 1498 7262, GRID grid.412176.7, Department of General Surgery, Faculty of Medicine, , Erzincan University, ; Erzincan, Turkey
                [32 ]ISNI 0000 0001 2166 9385, GRID grid.7149.b, Clinic for Emergency Surgery, , Medical Faculty University of Belgrade, ; Belgrade, Serbia
                [33 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Department of Surgery, Assia Medical Group, , Tel Aviv University Sackler School of Medicine, ; Tel Aviv, Israel
                [34 ]Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
                [35 ]ISNI 0000 0004 0469 2139, GRID grid.414959.4, Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, , Foothills Medical Centre, ; Calgary, Alberta Canada
                [36 ]ISNI 0000 0000 9950 8111, GRID grid.413731.3, Department of General Surgery, Division of Surgery, , Rambam Health Care Campus, ; Haifa, Israel
                [37 ]ISNI 0000 0004 0372 2033, GRID grid.258799.8, Department of Primary Care and Emergency Medicine, , Kyoto University Graduate School of Medicine, ; Kyoto, Japan
                [38 ]ISNI 0000 0004 0576 7753, GRID grid.414386.c, Department of Surgery, , Edendale Hospital, ; Pietermaritzburg, Republic of South Africa
                [39 ]Abdominal Center, University Hospital Meilahti, Helsinki, Finland
                [40 ]ISNI 0000 0001 2289 5077, GRID grid.412213.7, II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, , Universidad Nacional de Asuncion, ; Asuncion, Paraguay
                [41 ]ISNI 0000000122986657, GRID grid.34477.33, Department of Surgery, , University of Washington, ; Seattle, WA USA
                [42 ]ISNI 0000 0004 1771 1642, GRID grid.412572.7, Department of Surgery, , Pt BDS Post Graduate Institute of Medical Sciences, ; Rohtak, India
                [43 ]ISNI 0000 0004 0500 5353, GRID grid.412963.b, Department of Surgery, Radiology, , University Hospital of the West Indies, ; Kingston, Jamaica
                [44 ]Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
                [45 ]Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
                [46 ]ISNI 0000 0000 8878 5287, GRID grid.412975.c, Department of Surgery, , University of Ilorin, Teaching Hospital, ; Ilorin, Nigeria
                [47 ]ISNI 0000 0004 0411 3985, GRID grid.460946.9, Department of Surgery, , King Abdullah University Hospital, ; Irbid, Jordan
                [48 ]ISNI 0000 0001 2295 7397, GRID grid.8271.c, Department of Surgery and Critical Care, , Universidad del Valle, Fundación Valle del Lili, ; Cali, Colombia
                [49 ]Division of Emergency and Trauma Surgery, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
                [50 ]Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
                [51 ]Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
                [52 ]General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
                [53 ]ISNI 0000 0001 1011 3808, GRID grid.255464.4, Department of Aeromedical Services for Emergency and Trauma Care, , Ehime University Graduate School of Medicine, ; Ehime, Japan
                [54 ]GRID grid.240988.f, Department of General Surgery, , Tan Tock Seng Hospital, ; Tan Tock Seng, Singapore
                [55 ]ISNI 0000 0004 0627 2891, GRID grid.412835.9, Department of Gastrointestinal Surgery, , Stavanger University Hospital, ; Stravenger, Norway
                [56 ]ISNI 0000 0000 9100 9940, GRID grid.411798.2, First Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, , General University Hospital, ; Prague, Czech Republic
                [57 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Surgery, , Radboud University Medical Center, ; Nijmegen, The Netherlands
                [58 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, , Massachusetts General Hospital, ; Boston, USA
                [59 ]ISNI 0000 0004 1756 1461, GRID grid.454210.6, Trauma and Emergency Surgery Department, , Chang Gung Memorial Hospital, ; Taoyuan City, Taiwan
                [60 ]ISNI 0000 0001 0174 2901, GRID grid.414739.c, Department of Surgery, , Sheri-Kashmir Institute of Medical Sciences, ; Srinagar, India
                [61 ]ISNI 0000 0004 0453 3875, GRID grid.416195.e, Department of Trauma Surgery, , Royal Perth Hospital, ; Perth, Australia
                [62 ]ISNI 0000 0004 1766 361X, GRID grid.464618.9, Department of Surgery, , Mosc Medical College, ; Kolenchery, Cochin, India
                [63 ]Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
                [64 ]ISNI 0000 0004 1936 7443, GRID grid.7914.b, Department of Clinical Medicine, , University of Bergen, ; Bergen, Norway
                Article
                141
                10.1186/s13017-017-0141-6
                5504840
                28702076
                acea2518-c453-4a0f-bfc8-4a2dd42dc3a0
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 May 2017
                : 20 June 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Surgery
                intra-abdominal infections,sepsis,peritonitis,antibiotics
                Surgery
                intra-abdominal infections, sepsis, peritonitis, antibiotics

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