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

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

The effect of an intermediate care unit on the demographics and outcomes of a surgical intensive care unit population

Hypothesis: Many surgical intensive care units (SICUs) face bed shortages for acutely ill patients that may result from a large proportion of bed occupation by chronically ill patients. We hypothesized that the introduction of a new intermediate care or step-down unit (SDU) managed by surgically trained intensivists would allow the admission of more acutely ill patients while maintaining satisfactory outcomes. Design Prospective retrospective comparison of SICU patient populations before and after the introduction of an SDU. Setting The SICU of NewYork-Presbyterian Hospital, New York Weill Cornell Center, a university hospital containing a level I trauma center. Patients and Interventions All patients in the SICU admitted from August 1, 1996, through June 30, 1997, were SICU patients prior to the introduction of the SDU. Patients admitted from August 1, 1997, through June 30, 1998, were SICU post-SDU patients, and SDU patients included those admitted to the SDU from August 1, 1997, through July 1, 1998. Main Outcome Measures For each of the 2 eras, patients were compared for age, sources of admission, Acute Physiology and Chronic Health Evaluation (APACHE) II and III scores, unit length of stay, and mortality. Other data collected included origin of admission, nature of admission, and diagnosis. Results: Six hundred sixty-six patients were admitted during the pre-SDU era, while a total of 1117 patients (619 SICU and 498 SDU patients) were admitted in the post-SDU era. After the introduction of the SDU, the mean (standard deviation) APACHE II scores of the SICU and SDU patients increased (14.2 vs 13.4, P =3D .04) without affecting mortality (6.0% in the post-SDU era vs 8.2% in the pre-SDU era, P =3D .07). The post-SDU era had a higher proportion of emergency admissions (42.3% vs 48.6%, P<.05) and interhospital transfers (7% vs 1%). Conclusions: Opening an SDU resulted in a significant increase in the overall severity of the SICU population. Creation of an SDU managed by surgically trained intensivists may optimize the use of a hospital's resources, permit the expansion of emergency or tertiary care services, and improve outcomes for critically ill surgical patients

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

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