Piperacillin-tazobactam was the only antimicrobial agent to which all the isolates were susceptible. Similarly, imipenem, meropenem, and metronidazole were highly active (resistance, <0.5%), whereas the lowest susceptibility rates were noted for ciprofloxacin, and clindamycin. A recent multicenter study by Snydman et al. [193] determined

the susceptibility trends for the species of the Bacteroides fragilis group against various antibiotics from 1997 to 2004 by using data for 5,225 isolates referred by 10 medical centers in the United States. Resistance to carbapenems was rarely seen in this study (<1.5%). The trends in resistance to piperacillin-tazobactam, ampicillin-sulbactam, and cefoxitin were species dependent. Resistance of B. fragilis, to clindamycin

increased significantly, similar results were seen for moxifloxacin. Resistance rates for tigecycline CT99021 cost were low and stable during the 5-year period during which this agent was studied. Candida In the last years there has been a significant increase in the incidence of invasive infections due to Candida species. Candida intra-abdominal infections are associated with poor prognosis [195]. Thirty to forty percent of patients with recurrent gastrointestinal perforation/anastomotic leakage develop intra-abdominal invasive candidiasis [196]. ABT-737 research buy The most frequently implicated risk factors include the use of broad-spectrum antibacterial agents, use of central venous catheters, receipt of parenteral nutrition, receipt of renal all replacement therapy by patients in ICUs, neutropenia, and receipt

of immunosuppressive agents (including glucocorticosteroids, chemotherapeutic agents, and immunomodulators). Patients with health care-associated intra-abdominal infection are at higher risk of Candida peritonitis, particularly patients with recurrent gastrointestinal perforations and surgically treated pancreatic infection. Empiric antifungal therapy with fluconazole may decrease the incidence of Candida peritonitis in high-risk patients [103]. Fluconazole, is recommended as initial therapy [197]. An echinocandin (Caspofungin, Anidulafungin, or Micafungin) is preferred for patients with recent azole exposure, patients with moderately severe to severe illness, or patients who are at high risk of infection due to C. glabrata or C. krusei. Avoiding unnecessary antibiotics and optimizing the administration of antimicrobial agents will help to improve patient outcomes and minimize further pressures for resistance. Several strategies aim at achieving optimal use of antimicrobial agents, such as guidelines or protocols, restricting the hospital formulary, combining antibiotic therapy, antibiotic rotation, area-specific antimicrobial therapy, antimicrobial de-escalation and infections controls [198], but it is important that surgeons know antibiotic administration minimal requirements, such as antibiotics spectrum of activity and drug effective dosing.