The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection

Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri. JPS Health System, Fort Worth, Texas. 3 Department of Surgery, Vanderbilt University, Nashville, Tennessee. 4 Department of Surgery, University of Virginia, Charlottesville, Virginia. 5 Division of Pediatric Surgery, Children’s National Medical Center, Washington, DC. 6 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 7 Department of Surgery, University of Kentucky, Lexington, Kentucky. 8 Trauma Department, Abrazo West Campus, Goodyear, Arizona. 9 Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 10 Department of Surgery, Hofstra Northwell School of Medicine, Hempstead, New York. 11 Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 12 Departments of Surgery and Pediatrics, Hofstra-Northwell School of Medicine, Hempstead, New York. This document is available on the Surgical Infection Society website, .
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2 EXECUTIVE SUMMARY

MAZUSKI ET AL.
Surgical Infections 2017.18:1-76. Downloaded from by 103.70.220.28 on 05/20/17. For personal use only.
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ª John E. Mazuski, et al., 2016; Published by Mary Ann Liebert, Inc. This distributed under the terms of the Creative Commons Attribution Noncommercial License (/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
SURGICAL INFECTIONS Volume 18, Number 1, 2017 Mary Ann Liebert, Inc. DOI: 10.1089/sur.2016.261
The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection
Surgical Infections 2017.18:1-76. Downloaded from by 103.70.220.28 on 05/20/17. For personal use only.
1 2 3 4 5 John E. Mazuski, Jeffrey M. Tessier, Addison K. May, Robert G. Sawyer, Evan P. Nadler, 6 7 8 9 Matthew R. Rosengart, Phillip K. Chang, Patrick J. O’Neill, Kevin P. Mollen, 10 11 Jared M. Huston, Jose J. Diaz, Jr, and Jose M. Prince12
Abstract
Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. Results: This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. Summary: The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline.
Intra-abdominal infection (IAI) is a common disease process managed by surgical practitioners. The Surgical Infection Society (SIS) developed and disseminated guidelines for the management of these infections in 1992 [1], in 2002 [2,3], and most recently in 2010 as a joint guideline with the Infectious Diseases Society of America (IDSA) [4]. Since the 2010 guideline, additional challenges have arisen in the management of these infections, in part because of the aging of the population and the burden of chronic disease in these patients, and in part because of the increased prevalence of resistant bacteria and fungi in both the healthcare setting and the community. Nonetheless, advances in the management of these infections have also been made; newer approaches to source control are now available, as are new antibiotic agents that may meet some of the challenges posed by resistant pathogens. To maintain the clinical relevance of the guideline, the SIS appointed a task force to revise the 2010 guideline. This task force included members of the Therapeutics and Guidelines Committee as well as additional individuals from the SIS with expertise in the subject matter. The task force selected subjects from the previous guideline for updating, developed specific questions for review, and then used the best available contemporary evidence to formulate recommendations. The task force evaluated the quality of the evidence and the strength of the recommendations using the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) nomenclature, which has now become widely accepted as a standard for guidelines. Once completed, the entire document was subjected to external review by additional experts from the SIS, modified according to these reviews by consensus of the task force and sent to the Executive Council of the SIS for final approval. All judgments regarding interpretation of this evidence and the GRADE assignments were exercised by the members of the task force and subsequent reviewers based on their individual and collective expertise, recognizing that the evidence could be interpreted differently by others. As with previous guidelines, these recommendations were designed to support clinicians in making appropriate treatment decisions and not designed to supplant the judgment of the individual practitioner [4].