Intra-abdominal infections (IAIs) represent the second leading cause of severe infection in intensive care units, preceded only by respiratory tract and followed by skin and soft tissue infections. Commonly referred to as peritonitis, they can occur either at home (community-acquired IAIs) or in hospital 48 h after admission (hospital-acquired IAIs). Additionally, they may occur in patients at risk of colonization/infection by multi-resistant germs, known as healthcare-associated IAIs. In an emergency department, the most common causes of IAIs are appendicitis, cholecystitis, diverticulitis and perforations of the gastrointestinal tract. In 15–20% of cases, they present initially in the form of septic shock. During the COVID-19 era, patients with abdominal pain and fever tended to present to emergency departments later, resulting in their intra-abdominal pathology reaching more critical conditions, often leading to septic shock requiring immediate resuscitation and potentially intensive care unit admission before definitive surgical therapy. Survival, in community- and hospital-acquired IAIs, as well as in healthcare-associated peritonitis, is dependent on the promptness of diagnosis and etiological treatment, both surgically (source control) and with antibiotics. In cases of persistent infection, re-laparotomy and/or open abdominal cavity treatments may be necessary to radically and definitively control the intra-abdominal sepsis.

Background: Surgical site infections (SSI) are among the most frequently observed healthcare associated infections and represent a significant target to reduce the impact of antimicrobial resistance. Use of a surgical care bundle has demonstrated efficacy in reduction in SSI, but there is a lack of consensus on which elements should be included within such a bundle. The aim of this international consensus was to determine what factors should be utilized to produce an optimal, evidence-led bundle of care that can be utilized in a multidisciplinary manner across specialties and across countries. Methods: The process employed a modified Delphi methodology. Based on published high-level evidence an international multidisciplinary steering group developed 38 statements for testing with a wider responder panel of healthcare professionals in Europe. The threshold for consensus agreement was set at 75%. Results: A total of 820 responses were analyzed, with the majority of participants being surgeons (59%) and nurses (19.1%) from across Europe. The consensus process evaluated 36 finalized statements covering preoperative, intraoperative, and postoperative SSI prevention practices. Overall, 33 out of 36 statements (92%) reached the predefined consensus threshold of 75% agreement. A high agreement was observed across multiple roles and specialties, although some variation existed for specific topics such as antiseptic irrigation, use of antimicrobial sutures, and plastic adhesive drapes. Conclusion: This large consensus of European HCPs involved in the surgical care of patients achieved strong levels of consensus across most of the proposed statements on elements of an SSI prevention bundle. These practice recommendations could be adopted as an evidence- and expert-based care bundle for the prevention of SSI. The project was registered at www.researchregistry.com.

This chapter investigates the economic impact of surgical site infections (SSIs) on Italy’s National Health Service (NHS), highlighting the burden of SSIs on healthcare expenditure and patient care. Using Hospital Discharge Records from 2015 to 2021, the prevalence and economic consequences of SSIs across surgeries for diseases such as diverticulitis, appendicitis, cholecystitis, cholelithiasis, hernia, and ventral hernia were analyzed. The study focused on the extended hospital stays and additional costs associated with SSIs, estimating the economic burden on the NHS. The analysis included over 893,000 surgeries, identifying an average SSI rate of 0.23%, ranging from 0.07% and 1.35%. It was found that SSIs extended hospital stays by an average of 13 days and increased NHS costs by €4424 per admission, reflecting in a total economic burden of €18.8 million over the study period. SSIs have a significant epidemiological and economic burden on the NHS, underscoring the need for improved infection prevention and control measures. The study advocates for the implementation of more effective surgical protocols and practices to reduce the prevalence of SSIs, thereby enhancing patient outcomes and reducing the economic burden on the healthcare system.