🌟 ABX Pearl of the Day: empiric anaerobic coverage in intra-abdominal infections (IAI) 💡 Q: My patient is admitted with an acute biliary infection. Is empiric anaerobic coverage needed in this and other IAI? #IDsky #MedSky #PharmSky #SkyRX #AMSsky - ThreadSky

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stanfordasp.bsky.social • 93 days ago

🌟 ABX Pearl of the Day: empiric anaerobic coverage in intra-abdominal infections (IAI)

💡 Q: My patient is admitted with an acute biliary infection. Is empiric anaerobic coverage needed in this and other IAI?

#IDsky #MedSky #PharmSky #SkyRX #AMSsky

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stanfordasp.bsky.social•93 days ago

🔍 A: 🚫According to guidelines, empiric anaerobic coverage for community-acquired acute cholecystitis and cholangitis of mild/moderate severity is NOT recommended unless there's an entero-biliary anastomosis or emphysematous cholecystitis.

stanfordasp.bsky.social•93 days ago

📊 Why? Studies show very low recovery rates of anaerobic bacteria from biliary cultures and blood cultures in patients with acute cholecystitis or cholangitis.

stanfordasp.bsky.social•93 days ago

⚠️ In contrast, empiric anaerobic coverage is recommended for other intra-abdominal infections such as:
Appendicitis
Diverticulitis
Secondary & tertiary peritonitis
Infected necrotic pancreatitis

stanfordasp.bsky.social•93 days ago

🔗 For more details, refer to these guidelines:
IDSA Guidelines on Intra-Abdominal Infections
Tokyo Guidelines 2018 - Acute Cholangitis and Cholecystitis
SIS Guidelines on IAI - 2024 (DOI: 10.1089/sur.2024.137)
SHC Intra-Abdominal Infection Guideline (click link below)

impharmer.bsky.social•93 days ago

Not sure how many times every year we have to educate our surgical residents of this fact. Similarly, teaching them time and again why Augmentin is a terrible step-down choice for most of their IA infections that don't have culture data to guide therapy.

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