INTRA-ABDOMINAL INFECTIONS, HEPATITIS, AND GASTROENTERITIS (D BOBAK, SECTION EDITOR) Management of Intra-abdominal Infections due to Carbapenemase-Producing Organisms Paola Di Carlo & Francesco Vitale & Criostóir Ó’Súilleabháin & Alessandra Casuccio Published online: 17 August 2014 # Springer Science+Business Media New York 2014 Abstract The prevalence of bacterial resistance to carbapen- em antibiotics continues to increase because of bacteria pro- ducing metallo-β-lactamases (MBL), called carbapenemase- producing organisms (CPO). Enterobacteriaceae, which can be a common cause of intra-abdominal infections (IAIs), have become carbapenem-resistant Enterobacteriaceae (CRE). Updated international guidelines for the treatment of both IAIs and IAIs due to CRE have been published. Given the multi- faceted nature of these infections, these recommendations have been jointly reviewed and endorsed by the Surgical Society and the Association of Medical Microbiology and Infectious Disease. The aims of this review are to summarize the general and new generation of multimodal procedure to manage IAIs due to CRE and review the data available on the combination of interventions to reduce CRE. Future research should focus on the development of novel and safe antimicro- bial therapies and the quantification of the incremental effect of infection control programmes and new methods to rapidly detect pathogens before patients enter the surgical setting. Keywords Intra-abdominal infections . Carbapenemase-producing organisms . Carbapenem-resistant Enterobacteriaceae . Management of intra-abdominal infections Introduction Abdominal surgery carries significant morbidity and mortali- ty, which is in turn associated with an enormous use of health- care resources. Intra-abdominal infections are particularly sig- nificant as they occur relatively frequently and have potential- ly serious consequences; they can slow down patient recovery, prolong hospital stay, and require greater antibiotic use. Intra- abdominal infections (IAIs) comprise a wide variety of spe- cific infections, ranging from uncomplicated appendicitis to cholecystitis and faecal peritonitis, and are therefore classified as either uncomplicated or complicated such as intra- abdominal abscess or peritonitis. In the majority of uncompli- cated IAIs, definitive management is surgical and antibiotics are not warranted beyond prophylaxis of the incision against SSI. However, in certain instances, the pathogens extend beyond the source organ and into the peritoneal cavity through a perforated viscus, thereby stimulating the systemic inflam- matory response to a greater degree. The extent of such infection depends upon the combination of local host defences and the virulence of microorganisms [1]. Pyogenic liver abscesses usually develop following perito- nitis due to an intra-abdominal abscess that subsequently spreads to the liver via the portal circulation or via direct spread from a biliary infection. They may also result from arterial haematogenous seeding in the setting of a systemic infection. In such cases, sepsis is a serious complication and mortality is approximately 25–35 % [1–3, 4•] but may This article is part of the Topical Collection on Intra-abdominal Infections, Hepatitis, and Gastroenteritis P. Di Carlo : F. Vitale : A. Casuccio (*) Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy e-mail: alessandra.casuccio@unipa.it P. Di Carlo e-mail: paola.dicarlo@unipa.it F. Vitale e-mail: francesco.vitale@unipa.it C. Ó’Súilleabháin Mercy University Hospital, Grenville Place, Cork, Ireland e-mail: cbosullivan@muh.ie Curr Infect Dis Rep (2014) 16:428 DOI 10.1007/s11908-014-0428-7