The Authors concluded that the knowledge of these two factors might provide a more rational basis for selecting initial antimicrobial therapy for patients with complicated intra-abdominal infections. In order to investigate patient characteristics Small molecule library high throughput associated with a high risk of isolation of resistant pathogens from an intra-abdominal source, the results of a retrospective study by Swenson

et al. [106] were published recently. Complicated intra-abdominal and abdominal organ/space surgical site infections treated over a ten-year period in a single hospital were studied. A total of 2,049 intra-abdominal infections were treated during the period of study, of which 1,182 had valid microbiological data. Health care association, corticosteroid use, organ transplantation, liver disease, pulmonary disease, and a duodenal source all were associated with resistant pathogens. Low risk patients are generally those with community-acquired infections without risk factors. Intra-abdominal infections

in low risk LY2606368 clinical trial patients are associated with expected pathogens with known susceptibilities. Empirical agents in these patients must be directed at providing reliable activity against E coli, other gram negative facultative bacteria, and B fragilis. Antibiotic regimens with a broader spectrum of activity are not recommended for low risk patients with intra-abdominal infections, because such regimens may carry a greater risk of toxicity and facilitate Protirelin acquisition of more resistant organisms. Antimicrobial regimens Intra-abdominal infections may be managed with either single or multiple antimicrobial regimens. Recently the new guidelines for the management of complicated intra-abdominal infections by the Surgical Infection Society and the Infectious Diseases Society of America were published [103]. According to the guidelines, for adults with extra-biliary mild-to-moderate severity community acquired complicated

infections, the use of ticarcillin-clavulanate, cefoxitin, ertapenem, moxifloxacin, or tigecycline as single-agent therapy or combinations of metronidazole with cefazolin, cefuroxime, ceftriaxone, cefotaxime, levofloxacin, or ciprofloxacin are recommended [103]. For adults with extra-biliary high severity complicated infections, meropenem, imipenem-cilastatin, doripenem, piperacillin/tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole are recommended. Because of increasing resistance of Escherichia coli to fluoroquinolones, local population susceptibility profiles and, if available, isolate susceptibility should be always reviewed [103].