Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Sartelli, Massimo and Weber, Dieter G. and Ruppé, Etienne and Bassetti, Matteo and Wright, Brian J. and Ansaloni, Luca and Catena, Fausto and Coccolini, Federico and Abu-Zidan, Fikri M. and Coimbra, Raul and Moore, Ernest E. and Moore, Frederick A. and Maier, Ronald V. and De Waele, Jan J. and Kirkpatrick, Andrew W. and Griffiths, Ewen A. and Eckmann, Christian and Brink, Adrian J. and Mazuski, John E. and May, Addison K. and Sawyer, Rob G. and Mertz, Dominik and Montravers, Philippe and Kumar, Anand and Roberts, Jason A. and Vincent, Jean-Louis and Watkins, Richard R. and Lowman, Warren and Spellberg, Brad and Abbott, Iain J. and Adesunkanmi, Abdulrashid Kayode and Al-Dahir, Sara and Al-Hasan, Majdi N. and Agresta, Ferdinando and Althani, Asma A. and Ansari, Shamshul and Ansumana, Rashid and Augustin, Goran and Bala, Miklosh and Balogh, Zsolt J. and Baraket, Oussama and Bhangu, Aneel and Beltrán, Marcelo A. and Bernhard, Michael and Biffl, Walter L. and Boermeester, Marja A. and Brecher, Stephen M. and Cherry-Bukowiec, Jill R. and Buyne, Otmar R. and Cainzos, Miguel A. and Cairns, Kelly A. and Camacho-Ortiz, Adrian and Chandy, Sujith J. and Che Jusoh, Asri and Chichom-Mefire, Alain and Colijn, Caroline and Corcione, Francesco and Cui, Yunfeng and Curcio, Daniel and Delibegovic, Samir and Demetrashvili, Zaza and De Simone, Belinda and Dhingra, Sameer and Diaz, José J. and Di Carlo, Isidoro and Dillip, Angel and Di Saverio, Salomone and Doyle, Michael P. and Dorj, Gereltuya and Dogjani, Agron and Dupont, Hervé and Eachempati, Soumitra R. and Enani, Mushira Abdulaziz and Egiev, Valery N. and Elmangory, Mutasim M. and Ferrada, Paula and Fitchett, Joseph R. and Fraga, Gustavo P. and Guessennd, Nathalie and Giamarellou, Helen and Ghnnam, Wagih and Gkiokas, George and Goldberg, Staphanie R. and Gomes, Carlos Augusto and Gomi, Harumi and Guzmán-Blanco, Manuel and Haque, Mainul and Hansen, Sonja and Hecker, Andreas and Heizmann, Wolfgang R. and Herzog, Torsten and Hodonou, Adrien Montcho and Hong, Suk-Kyung and Kafka-Ritsch, Reinhold and Kaplan, Lewis J. and Kapoor, Garima and Karamarkovic, Aleksandar and Kees, Martin G. and Kenig, Jakub and Kiguba, Ronald and Kim, Peter K. and Kluger, Yoram and Khokha, Vladimir and Koike, Kaoru and Kok, Kenneth Y. Y. and Kong, Victory and Knox, Matthew C. and Inaba, Kenji and Isik, Arda and Iskandar, Katia and Ivatury, Rao R. and Labbate, Maurizio and Labricciosa, Francesco M. and Laterre, Pierre-François and Latifi, Rifat and Lee, Jae Gil and Lee, Young Ran and Leone, Marc and Leppaniemi, Ari and Li, Yousheng and Liang, Stephen Y. and Loho, Tonny and Maegele, Marc and Malama, Sydney and Marei, Hany E. and Martin-Loeches, Ignacio and Marwah, Sanjay and Massele, Amos and McFarlane, Michael and Melo, Renato Bessa and Negoi, Ionut and Nicolau, David P. and Nord, Carl Erik and Ofori-Asenso, Richard and Omari, AbdelKarim H. and Ordonez, Carlos A. and Ouadii, Mouaqit and Alves Pereira Júnior, Gerson and Piazza, Diego and Pupelis, Guntars and Rawson, Timothy Miles and Rems, Miran and Rizoli, Sandro and Rocha, Claudio and Sakakhushev, Boris and Sanchez-Garcia, Miguel and Sato, Norio and Segovia Lohse, Helmut A. and Sganga, Gabriele and Siribumrungwong, Boonying and Shelat, Vishal G. and Soreide, Kjetil and Soto, Rodolfo and Talving, Peep and Tilsed, Jonathan V. and Timsit, Jean-Francois and Trueba, Gabriel and Trung, Ngo Tat and Ulrych, Jan and van Goor, Harry and Vereczkei, Andras and Vohra, Ravinder S. and Wani, Imtiaz and Uhl, Waldemar and Xiao, Yonghong and Yuan, Kuo-Ching and Zachariah, Sanoop K. and Zahar, Jean-Ralph and Zakrison, Tanya L. and Corcione, Antonio and Melotti, Rita M. and Viscoli, Claudio and Viale, Perluigi (2016) Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World Journal of Emergency Surgery, 11. p. 33. ISSN 1749-7922

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Abstract

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

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