IDSA updates guidelines on complicated intra-abdominal infections
Click Here to Manage Email Alerts
Key takeaways:
- Advancements in imaging, risk stratification and antimicrobial stewardship are reflected in new guidelines for complicated intra-abdominal infections.
- The guidelines were updated for the first time since 2010.
The Infectious Diseases Society of America released updated guidelines on complicated intra-abdominal infections for the first time since 2010.
The 21 updated recommendations on risk assessment, use of diagnostic imaging and microbiologic evaluation of complex acute infections are the first in what will be a series of updates to the 2010 guidelines on complicated intra-abdominal infections (cIAIs).
IDSA said splitting guideline updates into parts is a new publishing model that will allow individual guidelines to be updated and released more quickly, ahead of publication of the full guideline.
According to Robert A. Bonomo, MD, professor of medicine, pharmacology, molecular biology and microbiology, biochemistry, and proteomics and bioinformatics at Case Western Reserve University School of Medicine and a lead author on the update, a lot has changed in the decade and a half since the guidelines were last updated.
We spoke with Bonomo to find out more about the new guidelines. His answers have been lightly edited for length and clarity.
Healio: What prompted this update to cIAI diagnostic and treatment guidelines, and why right now?
Bonomo: Medicine has changed a lot in 14 years. This updates the guidelines with new or evolving clinical knowledge. [In the old guidelines], they used the Apache score for risk stratification. We looked at Apache score vs. other scoring systems for risk stratification. We also tried to be more rigorous in our methodological review.
I think there’s been some significant advancement in some of the diagnostics and how we think about them. These diagnostics have influenced how we approach clinical practice. We didn’t cover everything. Therapy and surgery-related topics are still going to be addressed. But looking at what was published in 2010, I think an update was appropriate. A lot has happened.
Healio: How were the specific conditions and infections covered in the updated guidelines selected?
Bonomo: They’re the most common. Surgeons manage diverticulitis; interns treat diverticulitis; emergency room physicians diagnose and manage diverticulitis. [The same with] appendicitis. These things are the most common. Future research should focus on our understanding of these conditions.
I hope we stimulated some thought for future research and summarized what we know at this point.
Healio: What are the most significant updates among the newly published guidelines?
Bonomo: There are significant updates to risk stratification. We also looked at different imaging modalities for different patients. For example, you would avoid a CT scan or plain X-rays for younger people, or women to minimize radiation exposure. So we reviewed data other than just CT; we advanced our evaluation to MRI and ultrasound, which is more frequently used now.
We also addressed collecting cultures in a correct and meaningful way. We looked at what patients who are most at risk and asked: how can we use this information precisely; how can we exercise stewardship more effectively; and use microbiology to give more meaningful results? We want to gear the evaluation so that it’s the most meaningful and has the most impact on the patient. As readers will see, we will address clinical conditions and therapy even further in subsequent publications and continue to evaluate appendicitis and these infections [for future recommendations].
Healio: The guidelines call attention to imaging recommendations for specific populations. Can you explain the differences in use suggested in the updated guidelines?
Bonomo: Let’s take an example of a pregnant person. So, a pregnant person comes in with suspicion of appendicitis. In that person, we would take an ultrasound first in order to visualize it. The ultrasound would save the pregnant person and the developing fetus from radiation exposure. We would not want to expose vulnerable populations to potential radiation.
One of the things I learned from being on a Patient-Centered Outcomes Research Institute panel is that some of our practices have got to be very patient centered, including a patient-centric focus and attention to patient preferences. We can’t forget that it’s a two-way street — it’s the evaluator and person being evaluated. I want to put the patient first in this equation, so that’s what inspired a lot of our discussion.
Healio: Is there a main takeaway from the updated guidelines for clinicians who may need them?
Bonomo: This is an exceptionally important, clinically relevant and exciting area. The main takeaway is that we need to provide evidence-based care to our patients in addition to studying this more. Even though intra-abdominal infections are very common, there’s still so much to be learned. There is still a lot of information out there that needs to be examined and there are still studies that need to be done.
The decisions that we make as clinicians or doctors or nurses in one part of the world are going to be a little different than the decisions we make in another part of the world. How long should we prescribe antibiotics? what are the most effective? What’s the route? Those are really important clinical questions that we hope the guidelines serve as a springboard for future research to address.
Another main takeaway is that by [using] carefully, systematically studied data, we can improve the outcome of patients with these infections.
Lastly, we need to be more patient centric
References:
- Bonomo RA, et al. Clin Infect Dis. 2024;doi:10.1093/cid/ciae346.
- IDSA 2024 guideline update on the risk assessment, diagnostic imaging and microbiological evaluation of complicated intra-abdominal infections in adults, children and pregnant people. https://www.idsociety.org/practice-guideline/intra-abdominal-infections/. Updated July 13, 2024. Accessed Aug. 5, 2024.
- IDSA releases new guidelines for complicated intra-abdominal infections. https://www.idsociety.org/news--publications-new/articles/2024/idsa-releases-new-guidelines-for-complicated-intra-abdominal-infections/. Published July 13, 2024. Accessed Aug. 5, 2024.
Collapse
Healio Interviews
Click Here to Manage Email Alerts