Gennaro Perrone1, Massimo Sartelli2, Giuffrida Mario3, Alain Chichom-Mefire4, Francesco Maria Labricciosa5, Fikri M Abu-Zidan6, Luca Ansaloni7, Walter L Biffl8, Marco Ceresoli7, Federico Coccolini9, Raul Coimbra10, Zaza Demetrashvili11, Salomone Di Saverio12, Gustavo Pereira Fraga13, Vladimir Khokha14, Andrew W Kirkpatrick15, Yoram Kluger16, Ari Leppaniemi17, Ronald V Maier18, Ernest Eugene Moore19, Ionut Negoi20, Carlos A Ordonez21, Boris Sakakushev22, Helmut A Segovia Lohse23, George C Velmahos24, Imtaz Wani25, Dieter G Weber26, Elena Bonati27, Fausto Catena1. 1. Department of Emergency Surgery, Maggiore Hospital, Parma, Italy. 2. Department of Surgery, Macerata Hospital, Macerata, Italy. 3. Department of General Surgery, Maggiore Hospital, Parma, Italy. Electronic address: mario.giuffrida4@gmail.com. 4. Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon. 5. Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy. 6. Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. 7. General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy. 8. Acute Care Surgery at The Queen's Medical Center, John A. Burns School of Medicine, University of Hawai'i, Honolulu, USA. 9. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy. 10. Department of Surgery, UC San Diego Medical Center, San Diego, CA, USA. 11. Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia. 12. Department of General Surgery, University Hospital of Varese, University of Insubria, Varese, Italy. 13. Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil. 14. Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus. 15. Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, Alberta, Canada. 16. Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel. 17. Abdominal Center, University Hospital Meilahti, Helsinki, Finland. 18. Department of Surgery, University of Washington, Seattle, WA, USA. 19. Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO, USA. 20. Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania. 21. Department of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia. 22. General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria. 23. II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay. 24. Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, Massachusetts General Hospital, Boston, USA. 25. Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India. 26. Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia. 27. Department of General Surgery, Maggiore Hospital, Parma, Italy.
Abstract
BACKGROUND: Most remote areas have restricted access to healthcare services and are too small and remote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines. METHODS: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020. RESULTS: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible. CONCLUSIONS: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections.
BACKGROUND: Most remote areas have restricted access to healthcare services and are too small and remote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines. METHODS: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020. RESULTS: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible. CONCLUSIONS: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections.
Authors: Mateusz Jagielski; Wojciech Kupczyk; Jacek Piątkowski; Marek Jackowski Journal: Front Cell Infect Microbiol Date: 2022-07-05 Impact factor: 6.073