Original Title: Infections intra-abdominales chez l’adulte

Authors' objectives: Intra-abdominal infections (IAIs) generally develop as a result of inflammation of an organ in the abdominal cavity or a disruption of the gastrointestinal tract. These infections occur in a wide array of clinical conditions, e.g., intra-abdominal abscesses, appendicitis, cholangitis, cholecystitis, diverticulitis and peritonitis. The source of the infection is usually controlled surgically or with antibiotic therapy. The evolution and dissemination of antibiotic resistance is leading to a worrying decline in treatment efficacy. It has become urgent to avoid the overuse and misuse of antibiotics, especially in the context of IAIs. The most recent guidelines recommend measures such as: • Avoid antibiotic therapy in acute uncomplicated diverticulitis because it involves inflammation rather than immediate infection; • Use narrow-spectrum antibiotics in uncomplicated IAIs. Those changes have warranted the development of a new optimal use guide for the treatment of IAIs, which supersedes the one published in 2012.

Authors' results and conclusions: RESULTS (#1 THE IAI SEVERITY SHOULD GUIDE THE CHOICE OF ANTIBIOTIC THERAPY): The assessment of the severity includes the combination and accumulation of criteria associated with the origin and severity of the infection, as well as the individual's clinical characteristics and the presence of risk factors for multidrug resistance. • The IAI is then classified: mild to moderate or severe (#2 UNCOMPLICATED DIVERTICULITIS IS AN INFLAMMATORY, NOT AN INFECTIOUS, CONDITION THAT DOES NOT REQUIRE ANTIBIOTIC THERAPY): However, oral antibiotic therapy may be appropriate in uncomplicated diverticulitis if complication risk factors are present. • Complicated diverticulitis also requires antibiotic therapy and may range from mild to moderate or severe, depending on the presence of certain complications. (#3ANTIBIOTICS SHOULD BE PRESCRIBED RESPONSIBLY, ACCORDING TO THE SEVERITY OF THE INFECTION): The use of piperacillin/tazobactam, a broad-spectrum penicillin, should be reserved for severe infections only. (#4 INFECTIONS CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE-PRODUCING ENTEROBACTERIACEAE APPEAR TO BE ON THE RISE, AND THEIR MANAGEMENT BY FRONT-LINE PHYSICIANS, INCREASINGLY COMMON): Given the extent of the problem, the stakeholders considered it advisable to include recommendations covering such cases in the optimal use guide. CONCLUSION: Antibiotic governance is an important topic that was addressed in the guide. Appropriate treatment options, which are based on the severity of the infection, and preferred durations of treatment have been revisited in this regard. The new recommendations concerning the non-treatment of uncomplicated diverticulitis will have an impact on clinical practice. A willingness to change is observed among Québec clinicians. However, clear guidance and the uptake of the new recommendations will be necessary. Patients' acceptance of these new recommendations is likely to require ongoing education and support, especially for those with recurrent diverticulitis, who are accustomed to receiving antibiotics treatments. The harmonization of practice in Québec is essential and will depend on the dissemination of this guide, adherence to the proposed changes, and clear guidance from healthcare facilities.

Authors' methods: A systematic search of clinical practice guidelines, published between 2017 and April 2024 concerning IAIs and the acute clinical conditions in which these infections can occur, was conducted. • Guidelines on gynecological infections and Clostridioides difficile and Helicobacter pylori infections were excluded from the scope of this project as they were covered in other works that have been carried out at the INESSS. Guidelines solely focussing on surgical procedures, chronic infections or nonbacterial infections were also excluded. • The search for clinical practice guidelines in the databases and grey literature was conducted in collaboration with a scientific information consultant (librarian). Documents were selected according to preestablished criteria, and the quality of those selected was assessed using the AGREE-II appraisal tool. • An advisory committee consisting of clinicians and other health professionals from different specialties and areas of expertise (gastroenterologist, family physicians, pharmacists, microbiologist/infectious disease specialist, nurse and surgeon) validated the scientific evidence and were involved in drawing up recommendations. At the end of the project, an external validation of the work was also carried out, which involved external readers specializing in the field of interest, as well as future users of the optimal use guide developed.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/infections-intra-abdominales-chez-ladulte.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/infections-intra-abdominales-chez-ladulte.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)