Benefits of WSES guidelines application for the management of intra-abdominal infections

Belinda De Simone; Federico Coccolini; Fausto Catena; Massimo Sartelli; Salomone Di Saverio; Rodolfo Catena; Antonio Tarasconi; Luca Ansaloni

doi:10.1186/s13017-015-0013-x

Benefits of WSES guidelines application for the management of intra-abdominal infections

World J Emerg Surg. 2015 Mar 18:10:18. doi: 10.1186/s13017-015-0013-x. eCollection 2015.

Authors

Belinda De Simone¹, Federico Coccolini², Fausto Catena¹, Massimo Sartelli³, Salomone Di Saverio⁴, Rodolfo Catena⁵, Antonio Tarasconi⁶, Luca Ansaloni²

Affiliations

¹ Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 11, 43100 Parma, Italy.
² Department of General and Emergency Surgery, Papa Giovanni XIII Hospital, Bergamo, Italy.
³ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁴ Department of Surgery, Maggiore Hospital of Bologna, Bologna, Italy.
⁵ Oxford University, Oxford, Great Britain.
⁶ Ospedali Civili di Brescia, Brescia, Italy.

Abstract

Introduction: The use of antibiotics is very high in the departments of Emergency and Trauma Surgery above all in the treatment of the intra-abdominal infections, to decrease morbidity and mortality rates; often the antimicrobial drugs are prescribed without a rationale and they are second-line antibiotics; this clinical practice increases costs without decreasing mortality. Aim of our study is to report the results in the application to the clinical practice of the World Society Emergency Surgeons (WSES) guidelines for the management of intra-abdominal infections, at the department of Emergency and Trauma Surgery of the University Hospital of Parma (Italy) in 2012.

Methods: A retrospective observational analysis was carried out about patients admitted in the department of Emergency and Trauma Surgery of Parma (Italy), between January 2011 and December 2012. The data are expressed as percentages (%) and means (± SD). The results of the compared groups were analyzed using the Pearson's Chi-Square and Fisher's tests. For means involving continuous numerical data, the independent sample T test and the Mann-Whitney U-test were used for normally and abnormally distributed data, respectively (the data had been previously tested for normality using the Kolmogorov-Smirnov test). A p-value < 0.05 was considered statistically significant.

Results: Between January 2011 and December 2012, 2121 (968 in 2011 and 1153 in 2012) patients were admitted in the department of Emergency and Trauma Surgery (Italy) of Parma University Hospital with a diagnosis of acute IAI. Morbidity in 2012 was 10,2% compared to 22.7% in 2011 and mortality in 2012 was 1,1% compared to 3,2% in 2011 (p < 0,05). Costs for antibiotics in 2012 was 51392 euro, with a reduction of 31% compared to 2011.

Conclusions: This study demonstrates that an inexpensive and easily application of guidelines based on medicine evidence in the use of antibiotics can lead to a significative reduction of hospital costs with outcomes improvement.

Keywords: Antibiotics; Cost-effectiveness; Intra-abdominal infections; WSES guidelines.