Internal Medicine-Infectious Disease, Central Michigan University, Saginaw, MI, 48602, USA.
Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
BMC Infect Dis. 2019 Mar 29;19(1):293. doi: 10.1186/s12879-019-3829-2.
The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) is involved in antimicrobial stewardship. In an attempt at guiding clinicians across Lebanon in regards to the proper use of antimicrobial agents, members of this society are in the process of preparing national guidelines for common infectious diseases, among which are the guidelines for empiric and targeted antimicrobial therapy of complicated intra-abdominal infections (cIAI). The aims of these guidelines are optimizing patient care based on evidence-based literature and local antimicrobial susceptibility data, together with limiting the inappropriate use of antimicrobials thus decreasing the emergence of antimicrobial resistance (AMR) and curtailing on other adverse outcomes.
Recommendations in these guidelines are adapted from other international guidelines but modeled based on locally derived susceptibility data and on the availability of pharmaceutical and other resources.
These guidelines propose antimicrobial therapy of cIAI in adults based on risk factors, site of acquisition of infection, and clinical severity of illness. We recommend using antibiotic therapy targeting third-generation cephalosporin (3GC)-resistant gram negative organisms, with carbapenem sparing as much as possible, for community-acquired infections when the following risk factors exist: prior (within 90 days) exposure to antibiotics, immunocompromised state, recent history of hospitalization or of surgery and invasive procedure all within the preceding 90 days. We also recommend antimicrobial de-escalation strategy after culture results. Prompt and adequate antimicrobial therapy for cIAI reduces morbidity and mortality; however, the duration of therapy should be limited to no more than 4 days when adequate source control is achieved and the patient is clinically stable. The management of acute pancreatitis is conservative, with a role for antibiotic therapy only in specific situations and after microbiological diagnosis. The use of broad-spectrum antimicrobial agents including systemic antifungals and newly approved antibiotics is preferably restricted to infectious diseases specialists.
These guidelines represent a major step towards initiating a Lebanese national antimicrobial stewardship program. The LSIDCM emphasizes on development of a national AMR surveillance network, in addition to a national antibiogram for cIAI stratified based on the setting (community, hospital, unit-based) that should be frequently updated.
黎巴嫩传染病与临床微生物学会（LSIDCM）参与了抗菌药物管理。为尝试指导黎巴嫩各地的临床医生合理使用抗菌药物，该学会成员正在编写常见传染病的国家指南，其中包括复杂腹腔内感染（cIAI）经验性和靶向抗菌治疗指南。这些指南的目的是根据循证文献和当地抗菌药物敏感性数据优化患者治疗，同时限制抗菌药物的不当使用，从而减少抗菌药物耐药性（AMR）的出现，并减少其他不良后果。
这些指南中的建议是从其他国际指南改编而来，但基于本地获得的药敏数据和药物及其他资源的可获得性进行建模。
这些指南根据危险因素、感染部位和疾病严重程度为成人 cIAI 提出了抗菌治疗建议。我们建议对于社区获得性感染，如果存在以下危险因素，则使用针对第三代头孢菌素（3GC）耐药革兰氏阴性菌的抗生素治疗，尽可能减少碳青霉烯类药物的使用：在 90 天内使用过抗生素、免疫功能低下、最近有住院或手术史、90 天内有侵入性操作。我们还建议根据培养结果进行抗菌药物降阶梯策略。及时和适当的 cIAI 抗菌治疗可降低发病率和死亡率；然而，当达到适当的源头控制且患者临床稳定时，治疗时间应限制在不超过 4 天。急性胰腺炎的治疗以保守为主，仅在特定情况下且经微生物学诊断后才使用抗生素治疗。广谱抗菌药物（包括全身抗真菌药物和新批准的抗生素）的使用最好限制在传染病专家手中。
这些指南是朝着启动黎巴嫩国家抗菌药物管理计划迈出的重要一步。LSIDCM 强调建立国家 AMR 监测网络，以及根据（社区、医院、单位）设置分层的 cIAI 国家抗菌药物敏感性试验，应定期更新。
