ABSTRACT
Intra-abdominal infection (IAI) is a deadly condition in which the outcome is associated with urgent diagnosis, assessment and management, including fluid resuscitation, antibiotic administration while obtaining further laboratory results, attaining precise measurements of hemodynamic status, and pursuing source control. This last item makes abdominal sepsis a unique treatment challenge. Delayed or inadequate source control is an independent predictor of poor outcomes and recognizing source control failure is often difficult or impossible. Further complicating issue in the debate is surrounding the timing, adequacy, and procedures of source control. This review evaluated and summarized the current approach and challenges in IAI management, which are the future research directions.
Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Drainage , Fluid Therapy , Hemodynamics , Intraabdominal Infections/therapy , Laparoscopy , Laparotomy , Prognosis , SepsisABSTRACT
Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made. Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage, laparotomy or open abdominal therapy could be considered according to the sepsis severity. Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction. Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function. Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function. Once the treatment failure is made, the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus. The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage.
ABSTRACT
Source control of intra-abdominal infections is an important part in the treatment of intra-abdominal sepsis,which mainly includes drainage,elimination of necrotic tissue,control of sepsis as well as restoration of anatomy and function of gastrointestinal tract.Source control should be taken immediately after ascertaining intra-abdominal infections.Specific measures of source control include percutaneous drainage,surgery,open abdomen and antimicrobial therapy.The key to percutaneous drainage is accurate location and adequate drainage.When performing surgical drainage,extent of trauma should be restricted while accurate location and avoiding omissions.Accurate timing of open abdomenand definitive abdominal closure,proper selection of temporary abdominal closure method,avoiding complications of OA,and enteral nutrition are essentials of successful definitive abdominal closure and reduction of complications.Effective antimicrobial therapy relies on time,type selection and avoiding antibiotic abuse.Factors should be searched for rigorously after failure to control intra-abdominal sepsis.Comprehensive global treatment is not only the basis but also the countermeasure of source control.
ABSTRACT
In these years, renewal of the concept of sepsis, application of qSOFA and proposal of hour-1 bundle for sepsis further suggested to diagnose and treatment of sepsis earlier and faster than before. It presents new challenges to current clinical practice and asks us to be more alert to forewarning symptoms of patients, optimize hospital management procedures, strengthen training exercises and multidisciplinary collaboration in order to achieve optimal treatment of sepsis.
ABSTRACT
Source control should be performed as soon as possible once the diagnosis of intra-abdominal infection made.Surgical intervention should be considered when resuscitating the intra-abdominal infection with sepsis or septic shock and percutaneous abscess drainage,laparotomy or open abdominal therapy could be considered according to the sepsis severity.Treatment failure may be diagnosed if there is no any improvement in the systematic inflammatory reaction and multiple organ dysfunction.Interleukin 6 and procalcitonin combined with blood white cell count and C-reactive protein could reflect the systematic inflammatory reaction and Sequential Organ Failure Assessment can evaluate if there is any improvement of organ function.Bilirubin is a sensitive indicator of liver function in intra-abdominal infection and its persistent increasing usually means the deterioration of liver function.Once the treatment failure is made,the re-intervention should be performed as soon as possible and B ultrasound or CT should be done before operation to define the precise infected focus.The bacteria information should be retrieved before or during the intervention to guide the postoperative antibiotics usage.
ABSTRACT
Multiple factors can lead to treatment failure and death in the patients with intra-abdominal infection.These factors include advanced age,malignancy,significant cardiovascular compromise,significant liver and renal diseases,hypoalbuminemia,diffuse peritonitis,delayed initial source control,delayed and unexpected initial source control,and suspected infection with resistant pathogens.Scoring system such as Mannheim Peritonitis Index (MPI) and complicated intra-abdominal score can also help to evaluate the risk of intra-abdominal infection patients.Sepsis and septic shock are important risk factors.Treatment strategies include prompt resuscitation and organ function support,early appropriate source control measures,effective antibiotics coverage of pathogens,prevention and treatment of resistant bacterial.
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Objective To evaluate the effect of comprehensive schistosomiasis control measures based on infection source control in plateau mountain areas of Yunnan Province. Methods From 2006 to 2004,four administrative villages were selected as test areas from plateau canyon and plateau basin endemic areas in Jindun Town,Heqing County,two villages each type,and the comprehensive control measures were implemented,including the examination and treatment of schistosomiasis,Oncomela?nia hupensis snail survey and control,health education,improving drinking water and lavatories,banning grazing,constructing sanitary pen of livestock,replacing cattle with machine,etc. The schistosome infection state and snail status in 2006 were treat?ed as the baseline information,and the effect of the comprehensive measures were evaluated. Results The infection rate of hu?man in plateau canyon areas decreased from 4.94%in 2006 to 0.06%in 2014,and that of livestock decreased from 1.11%to 0. In plateau basin areas,there was only 1 case of schistosomiasis found in Xiaolian Village in 2007,and no any other cases found in the other years,the infection rates of livestock dropped from 7.38%to 0. Compared with 2006,the snail areas in the two type areas decreased by 74.89%and 75.30%,respectively,meanwhile,the percentage of snail area,the occurrence rate of frames with snails,as well as the average density of living snails also decreased,and no infected snails were found since 2008. Xidian and Xinzhuang villages in plateau canyon area reached the criteria of schistosomiasis transmission controlled in 2009,and Xiao?lian and Kangfu villages in plateau basin reached the criteria of transmission interrupted in 2014. Conclusions The comprehen?sive schistosomiasis control measures based on infection source control can effectively control the endemic situation of schistoso? miasis in plateau areas of Yunnan Province. In the future,we should pay an equal attention to the infection sources control and snail control to consolidate and amplify the achievement of schistosomiasis control.
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Objective To evaluate the long?term effect of the comprehensive control strategy for schistosomiasis with empha?sis on infectious source control in marshland?type endemic areas of Poyang Lake. Methods Three heavy endemic villages with schistosomiasis in the lake areas were selected as pilots for the comprehensive control strategy which included replacing bovine with tractors and forbidding grazing on marshlands. The data of schistosome infections of residents and Oncomelania hupensis snails were collected and analyzed statistically from 2009 to 2014. Results There were no patients with schistosomiasis through feces examinations in the 3 pilot villages. The average density of live snails in Niuzhou marshland showed a decline trend and the density was stable in Liulingwei marshland. There were no infected snails in the 2 marshlands and no schistosome adult worms were found in the sentinel rats Conclusion The implantation of the comprehensive control strategy for schistosomiasis with em?phasis on infectious source control can control the prevalence of schistosomiasis during a long period.
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Objective To evaluate the effect of a new schistosomiasis control strategy based on the infection source control in four-lake regions of Hubei Province. Methods The new strategy based on the infection source control included the safe water sup-ply,feces harmless treatment,replacing cattle with machine,captive livestock,chemotherapy,Oncomelania hupensis snail con-trol in susceptible areas,hardening ditches,etc,and the new control strategy was implemented for 7 years in 9 counties(cities or districts)of the four-lake regions. The schistosomiasis situations were investigated before and after the intervention of the new strat-egy. Results The coverage rates of feces harmless toilets(three format toilets),biogas digesters,and safe water supply were 42.00%,23.16% and 93.76%,respectively. The number of ditch hardening was 1 960;the area of eliminating snails was 1 378.42 hm2;the number of persons who received the health education was 3 524 818 accounting for 92.17%of the total popula-tion;the number of person-time of taking active protection measures was 516 636 963. The average annual decline rates of schisto-some infection were 24.42%and 38.38%in residents and cattle,respectively. The endemic villages decreased by 4.77%,the vil-lages with snails decreased by 7.05%,and the villages with snails accounted between 63.19%and 66.21%of the total endemic vil-lages. The area with snails decreased by 90.35%,and the advance schistosomiasis patients decreased by 5.55%,and the fatality rate of advanced schistosomiasis patients decreased by 1.24%. No acute schistosomiasis patients occurred. Type One and Two en-demic(heavy endemic)villages decreased to zero;Type Three endemic(moderate endemic)villages decreased by 10.22%;but Type Four endemic(mild endemic)villages increased by 66.38%;and Type Five endemic(no endemic for 5 years)villages de-creased by 0.22%. The standards of schistosomiasis transmission controlled have achieved on schedule. Conclusion The imple-mentation of the new schistosomiasis control strategy based on the infection source control in four-lake regions of Hubei Province can effectively control schistosomiasis.
ABSTRACT
Objective To evaluate the effect of comprehensive schistosomiasis control measures based on infection source control in Hanchuan City marshland and lake endemic regions . Methods The data of comprehensive schistosomiasis control in Hanchuan City from 2004 to 2013 were collected and the change trends of the Oncomelania hupensis snail status and the in?fection situation of human and livestock were analyzed to evaluate the control effect. Results After the implementation of the comprehensive measures the infection rates of residents and cattle decreased from 6.38%and 8.11%in 2004 to 0.16%and 0 in 2013 respectively. There were no acute schistosomiasis patients since 2007 no new infection cases since 2011 and no infected snails since 2012. Compared with 2004 the occurrence rate of frames with living snails and the average density of living snails decreased by 56.78%and 68.35% respectively but the snail area and susceptible area increased by 0.62%and 7.10% respec?tively. In 2013 all the 367 endemic villages in 26 townships reached the criteria of transmission controlled. Conclusions The comprehensive schistosomiasis control measures based on infection source control can control the schistosomiasis transmission effectively in marshland and lake endemic regions. When consolidating the achievement the snail area in inner embankment should be compressed to prevent the schistosome re?infection in human and livestock.