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The Value and Interpretation of Microbiological Specimens in the Management of cIAI

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Abdominal Sepsis

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

In the context of complicated intra-abdominal infections (cIAI), the fact is we are dealing with a diverse and complicated ecosystem of micro-organisms, a world we are only recently beginning to understand. The complexity of this ecosystem confounds us in managing patients with cIAI because we do not fully appreciate the microbial milieu and its impact on a healthy gut. Yet we blindly throw antimicrobials at patients in abundance, hoping to clear the offending pathogen(s). We need to understand the role of the microbe(s) in this complex interaction, and to do this, we need to identify the microbe(s) involved. This, coupled with advances in microbial identification, the escalation of multidrug resistant organisms (MDRO) and the difficulty in identifying patients at risk of harbouring MDRO, makes the appropriate collection of microbiological specimens of paramount importance. It is through appropriate collection, coupled with insightful interpretation and clinical contextualization of the microbiological results thereof, that we can optimize treatment and more effectively manage our patients

“There is nothing more deceptive than an obvious fact”.

Sherlock Holmes, in Arthur Conan Doyle: The Boscombe Valley Mystery

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References

  1. Renteria MI, Biedenbach DJ, Bouchillon SK, Hoban DJ, Raghubir N, Sajben P, et al. In vitro activity of tigecycline against isolates collected from complicated skin and skin structure infections and intra-abdominal infections in Africa and Middle East countries: TEST 2007-2012. Diagn Microbiol Infect Dis. 2014;79(1):54–9.

    Article  CAS  PubMed  Google Scholar 

  2. Yang Q, Zhang H, Wang Y, Xu Y, Chen M, Badal RE, et al. A 10 year surveillance for antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae in community- and hospital-associated intra-abdominal infections in China. J Med Microbiol. 2013;62(Pt 9):1343–9.

    Article  PubMed  Google Scholar 

  3. Biedenbach DJ, Bouchillon SK, Hoban DJ, Hackel M, Phuong DM, Nga TT, et al. Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: report from the study for monitoring antimicrobial resistance trends (SMART 2009–2011). Diagn Microbiol Infect Dis. 2014;79(4):463–7.

    Article  CAS  PubMed  Google Scholar 

  4. Kazmierczak KM, Lob SH, Hoban DJ, Hackel MA, Badal RE, Bouchillon SK. Characterization of extended-spectrum beta-lactamases and antimicrobial resistance of Klebsiella pneumoniae in intra-abdominal infection isolates in Latin America, 2008–2012. Results of the study for monitoring antimicrobial resistance trends. Diagn Microbiol Infect Dis. 2015;82(3):209–14.

    Article  CAS  PubMed  Google Scholar 

  5. Lob SH, Badal RE, Hackel MA, Sahm DF. Epidemiology and antimicrobial susceptibility of gram-negative pathogens causing intra-abdominal infections in pediatric patients in Europe-SMART 2011–2014. J Pediatric Infect Dis Soc. 2017;6(1):72–9.

    PubMed  Google Scholar 

  6. Hawser SP, Badal RE, Bouchillon SK, Hoban DJ, Hackel MA, Biedenbach DJ, et al. Susceptibility of gram-negative aerobic bacilli from intra-abdominal pathogens to antimicrobial agents collected in the United States during 2011. J Infect. 2014;68(1):71–6.

    Article  PubMed  Google Scholar 

  7. Zalacain M, Biedenbach DJ, Badal RE, Young K, Motyl M, Sahm DF. Pathogen prevalence and antimicrobial susceptibility among Enterobacteriaceae causing hospital-associated intra-abdominal infections in adults in the United States (2012–2013). Clin Ther. 2016;38(6):1510–21.

    Article  CAS  PubMed  Google Scholar 

  8. Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg. 2014;9:37.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bassetti M, Righi E, Ansaldi F, Merelli M, Scarparo C, Antonelli M, et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 2015;41(9):1601–10.

    Article  PubMed  Google Scholar 

  10. Vergidis P, Clancy CJ, Shields RK, Park SY, Wildfeuer BN, Simmons RL, et al. Intra-abdominal candidiasis: the importance of early source control and antifungal treatment. PLoS One. 2016;11(4):e0153247.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chowdhary A, Voss A, Meis JF. Multidrug-resistant Candida auris: ‘new kid on the block’ in hospital-associated infections? J Hosp Infect. 2016;94(3):209–12.

    Article  CAS  PubMed  Google Scholar 

  12. Janda WM. The genus streptococcus. Clin Microbiol Newsl. 2014;36(20):157–66.

    Article  Google Scholar 

  13. Hentges DJ. The anaerobic microflora of the human body. Clin Infect Dis. 1993;16(Suppl 4):S175–80.

    Article  PubMed  Google Scholar 

  14. Boyanova L, Kolarov R, Mitov I. Recent evolution of antibiotic resistance in the anaerobes as compared to previous decades. Anaerobe. 2015;31:4–10.

    Article  CAS  PubMed  Google Scholar 

  15. Snydman DR, Jacobus NV, McDermott LA, Golan Y, Hecht DW, Goldstein EJ, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005–2007). Clin Infect Dis. 2010;50(Suppl 1):S26–33.

    Article  PubMed  Google Scholar 

  16. Schuetz AN. Antimicrobial resistance and susceptibility testing of anaerobic bacteria. Clin Infect Dis. 2014;59(5):698–705.

    Article  PubMed  Google Scholar 

  17. Goldstein EJ, Citron DM, Goldman PJ, Goldman RJ. National hospital survey of anaerobic culture and susceptibility methods: III. Anaerobe. 2008;14(2):68–72.

    Article  CAS  PubMed  Google Scholar 

  18. Crump JA, Sjolund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive salmonella infections. Clin Microbiol Rev. 2015;28(4):901–37.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Thielman NM, Guerrant RL. Enteric fever and other causes of abdominal symptoms with fever. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 1. 6th ed. Amsterdam: Elsevier; 2005. p. 1273–86.

    Google Scholar 

  20. Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, et al., editors. Manual of clinical microbiology. 11th ed. Washington, DC: ASM Press; 2015.

    Google Scholar 

  21. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133–64.

    Article  PubMed  Google Scholar 

  22. Baron EJ, Sharp SE. Clarification on specimen collection and transportation for intra-abdominal infections. Clin Infect Dis. 2010;51(6):759.

    Article  Google Scholar 

  23. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis. 2013;57(4):e22–e121.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ntusi N, Aubin L, Oliver S, Whitelaw A, Mendelson M. Guideline for the optimal use of blood cultures. S Afr Med J. 2010;100(12):839–43.

    Article  PubMed  Google Scholar 

  26. CLSI. Performace standards for antimicrobial susceptibility testing. 26th edn. CLSI supplement M100S. Wayne, PA: Clinical and Laboratory Standards Institute; 2016.

    Google Scholar 

  27. EUCAST. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. http://www.eucast.org2016.

  28. Gutierrez-Gutierrez B, Perez-Galera S, Salamanca E, de Cueto M, Calbo E, Almirante B, et al. A multinational, preregistered cohort study of beta-lactam/beta-lactamase inhibitor combinations for treatment of bloodstream infections due to extended-Spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother. 2016;60(7):4159–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sartelli M, Weber DG, Ruppe E, Bassetti M, Wright BJ, Ansaloni L, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg. 2016;11:33.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lodise TP, Lomaestro BM, Drusano GL. Application of antimicrobial pharmacodynamic concepts into clinical practice: focus on beta-lactam antibiotics: insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2006;26(9):1320–32.

    Article  CAS  PubMed  Google Scholar 

  31. Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, Daikos GL. Treating infections caused by carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect. 2014;20(9):862–72.

    Article  CAS  PubMed  Google Scholar 

  32. Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother. 2014;58(4):2322–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012;55(7):943–50.

    Article  CAS  PubMed  Google Scholar 

  34. Lowman W, Schleicher G. Antimicrobial treatment and outcomes of critically ill patients with OXA-48like carbapenemase-producing Enterobacteriaceae infections. Diagn Microbiol Infect Dis. 2015;81(2):138–40.

    Article  CAS  PubMed  Google Scholar 

  35. Westphal JF, Brogard JM, Caro-Sampara F, Adloff M, Blickle JF, Monteil H, et al. Assessment of biliary excretion of piperacillin-tazobactam in humans. Antimicrob Agents Chemother. 1997;41(8):1636–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Rubino CM, Ma L, Bhavnani SM, Korth-Bradley J, Speth J, Ellis-Grosse E, et al. Evaluation of tigecycline penetration into colon wall tissue and epithelial lining fluid using a population pharmacokinetic model and Monte Carlo simulation. Antimicrob Agents Chemother. 2007;51(11):4085–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Mouton JW, Brown DF, Apfalter P, Canton R, Giske CG, Ivanova M, et al. The role of pharmacokinetics/pharmacodynamics in setting clinical MIC breakpoints: the EUCAST approach. Clin Microbiol Infect. 2012;18(3):E37–45.

    Article  CAS  PubMed  Google Scholar 

  38. Roberts JA, Paul SK, Akova M, Bassetti M, De Waele JJ, Dimopoulos G, et al. DALI: defining antibiotic levels in intensive care unit patients: are current beta-lactam antibiotic doses sufficient for critically ill patients? Clin Infect Dis. 2014;58(8):1072–83.

    Article  CAS  PubMed  Google Scholar 

  39. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E, Kirby A, Tilley R, Torok ME, et al. Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. 2011;11(3):208–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Warren Lowman

  2. Vermaak and Partners/Pathcare Pathologists, University of the Witwatersrand, Johannesburg, South Africa

    Warren Lowman

  3. Wits Donald Gordon Medical Centre, Johannesburg, South Africa

    Warren Lowman

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  1. Warren Lowman
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Correspondence to Warren Lowman .

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Editors and Affiliations

  1. Department of Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  2. University of Udine, Infectious Diseases Division , Udine, Italy

    Matteo Bassetti

  3. St James's University Hospital, Trinity Centre for Health Sciences , Dublin, Ireland

    Ignacio Martin-Loeches

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Lowman, W. (2018). The Value and Interpretation of Microbiological Specimens in the Management of cIAI. In: Sartelli, M., Bassetti, M., Martin-Loeches, I. (eds) Abdominal Sepsis. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-59704-1_20

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  • DOI: https://doi.org/10.1007/978-3-319-59704-1_20

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