ABSTRACT
Intra-abdominal infections (IAI) is common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The principles of IAI management included early diagnosis, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using critical care resources, combined with an optimal surgical approach. In order to facilitate clinical management, establish a global standard and provide guidance for clinicians, the World Society of Emergency Surgery (WSES), the Global Alliance for Infection in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) worked together to complete an international multi-society document, which provided the evidence-based clinical pathways. Herein, we made a comprehensive interpretation for the clinical pathways combined with the latest domestic and international research developments, aiming to provide evidence for domestic doctors on the diagnosis and treatment of IAI, and ultimately benefit patients.
ABSTRACT
Objective:To investigate the correlation between lung ultrasound score at the end of spontaneous breathing trial (SBT) and cumulative fluid balance at 48 h and their predictive value of extubation outcome in patients with intro-abdominal infection (IAI) under mechanical ventilation.Methods:A retrospective study was conducted. Patients with IAI under mechanical ventilation for more than 48 h were collected from three hospitals from October 1, 2017 to September 30, 2018. Routine demographic variables and clinical characteristics were recorded. The patients were divided into the successful extubation group and failed extubation group according to whether they could maintain spontaneous breathing for 48 h after extubation. LUS at the end of SBT (before extubation) and cumulative fluid balance at 48 h were compared between the two groups. LUS and cumulative fluid balance at 48 h were analyzed by bivariate correlation analysis, and their correlations with shallow fast breathing index (RSBI) and precursor protein of BNP (Pro-BNP) were analyzed. The predictive value of LUS at the end of SBT (before extubation) and cumulative fluid balance for extubation failure were analyzed by receiver operating characteristic curve (ROC).Results:Totally 207 patients were enrolled. There were significant differences in LUS before extubation [12 (10, 14) vs. 16 (14, 17) points], cumulative fluid balance [-318 (-1 116, 200) mL vs. 1 140 (685, 1 614) mL], RSBI [60 (55, 66) (times/min)/L vs. 70 (65, 78) (times/min)/L], pro-BNP [250 (122, 1 292) pg/mL vs. 1156 (285, 4 346) pg/mL], IAP >15 mmHg [32.8% vs. 46.6%], and ICU stay [8 (6, 12) days vs. 11 (8, 14) days] ( P<0.05). Logistic regression analysis showed that the COPD history, RSBI, LUS at the end of SBT, and cumulative fluid balance at 48 h before extubation were independent risk factors for extubation failure. Correlation analysis showed that LUS was moderately correlated with cumulative fluid balance at 48 h ( r=0.41, P<0.001), weakly correlated with RSBI ( r=0.381, P<0.001), and weakly correlated with pro-BNP ( r=0.220, P<0.001). Cumulative fluid balance at 48 h was weakly correlated with RSBI ( r=0.31, P<0.001), but not with pro-BNP. LUS at the end of SBT and cumulative liquid balance at 48 h had predictive value for extubation failure [AUC=0.87 (95% CI: 0.82-0.91), AUC=0.89 (95% CI: 0.85-0.94), P<0.001]. Conclusions:There is a moderate correlation between LUS at the end of SBT (before extubation) and 48 h cumulative fluid balance in patients with IAI and mechanical ventilation. LUS at the end of SBT (before extubation) and cumulative fluid balance at 48 h have some predictive value for extubation failure.
ABSTRACT
A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.
ABSTRACT
OBJECTIVE To investigate the treatment plan for az treonam-resistant metallo- β-lactamase（MBL）-producing Enterobacteriaceae infection in pediatric solid organ transplant recipients. METHODS The clinical data of aztreonam-resistant MBL-producing Klebsiella pneumoniae caused intra-abdominal infection of an infant after liver transplantation were retrospectively analyzed. Abdominal infection occurred after operation. The pathogenic bacterium was MBL-producing K. pneumoniae . The drug sensitivity results showed that the infant was resistant to aztreonam. Based on the results of sensitivity test ，polymyxin B combined with tigecycline were selected as initial regimen. The treatment effect was poor ，with recurrent disease and shock spots. The clinical pharmacist assisted the clinician to formulate treatment regimen of ceftazidime avibactam 0.5 g，q8 h combined with aztreonam 0.18 g，q6 h. Relevant domestic and foreign literature were reviewed ，and the treatment plan of MBL-producing Enterobacteriaceae infection after solid organ transplantation was summarized. RESULTS & CONCLUSIONS The infant was finally cured and discharged with ceftazidime avibatan combined and aztreonam. Several foreign literature reported that ceftazidime avibactam combined with aztreonam could effectively treat the infection caused by aztreonam-resistant MBL-producing Enterobacteriaceae infection in patients with organ transplantation. It is expected to be an effective treatment for aztreonam-resistant MBL-producing Enterobacteriaceae infection in pediatric solid organ transplant recipients.
ABSTRACT
ABSTRACT Ceftazidime/avibactam (CAZ/AVI) has excellent in vitro activity against enterobacterales and Pseudomonas aeruginosa. The study aimed to analyze the in vitro antimicrobial activity of CAZ/AVI and other antibiotics against isolates of enterobacterales and P. aeruginosa from patients with complicated urinary tract infection (cUTI) and complicated intra-abdominal infection (cIAI) in Colombian hospitals between 2014 and 2018, using the Antimicrobial Testing Leadership and Surveillance (ATLAS) database. Enterobacterales and P. aeruginosa samples were obtained from patients with cUTI and cIAI. Susceptibility was determined using The Clinical and Laboratory Standards Institute (CLSI) breakpoints. Meropenem-non-susceptible isolates were screened for extended-spectrum b-lactamase (ESBL) production. Isolates that were positive for ESBL activity were examined by Multiplex Polymerase Chain Reaction (Multiplex PCR) to detect genotypic resistance. A total of 565 Enterobacterales and 95 P. aeruginosa from patients with cUTI and 345 Enterobacterales and 65 P. aeruginosa from patients with cIAI were isolated. In vitro activity showed susceptibility to CAZ/AVI greater than 99% for Enterobacterales and in lower percentages for P. aeruginosa in cUTI (78.46%) and cIAI (83.33%). CAZ/AVI showed good in vitro activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa in patients with cUTI and cIAI.
ABSTRACT
Intra-abdominal infection is often secondary to the injury or lesion of various organs in the abdominal cavity, or after abdominal surgery. With the continuous development of its concept and technology, nutritional support has gradually become one of the important means for the treatment of patients with intra-abdominal infection. The comprehensive treatment of abdo-minal infection includes controlling of infection source, reasonable antimicrobial therapy, supporting of organ function, nutritional treatment, regulating of immune function, etc. Combined with their clinical experiences, the authors review the relevant researches at home and abroad and analyze and expound the nutritional support strategies for patients with intra-abdominal infection.
ABSTRACT
Objective:To compare the early and late predictive values of critical illness score (CIS) and procalcitonin (PCT) in septic patients with blood stream infection (BSI) induced by intra-abdominal infection (IAI), and to identify the value of PCT in etiological diagnosis.Methods:The clinical data of patients with at least one positive blood culture within 24 hours admission to the emergency department of China-Japan Friendship Hospital from January 2014 to December 2019 and with final diagnosis of IAI induced sepsis were enrolled. Sequential organ failure assessment (SOFA), mortality in emergency department sepsis (MEDS), Logistic organ dysfunction system (LODS), and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores were calculated based on the parameters on the day of admission. Differences in various indicators among different Gram-stained bacterial infections and among patients with different prognosis at 28 days or 60 days were compared. Receiver operator characteristic curve (ROC curve) was used to analyze the value of PCT in differential etiological diagnosis of IAI induced sepsis caused by single bacterial infection, and the predictive value of CIS and PCT on 28-day and 60-day death of septic patients with BSI induced by IAI.Results:A total of 221 septic patients with IAI caused by single bacterial infection were enrolled. The 28-day mortality was 19.9% (44/221), and the 60-day mortality was 25.8% (57/221). Mortality caused by Gram-positive (G +) bacterial infection of patients was significantly higher than that caused by Gram-negative (G -) bacterial infection (28 days: 34.6% vs. 11.4%, 60 days: 42.0% vs. 16.4%, both P < 0.01). Compared with patients with G + bacterial infection, the PCT value of patients with G - bacterial infection was higher [μg/L: 4.31 (0.71, 25.71) vs. 1.29 (0.32, 10.83), P < 0.05]. Compared with survival group, the values of CIS and PCT in death group were higher, either in 28 days or in 60 days [death group vs. survival group in 28 days: SOFA score was 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 11 (9, 14) vs. 6 (6, 9), LODS score: 4.0 (2.0, 6.0) vs. 1.0 (0, 2.0), APACHEⅡ score: 17.0 (15.0, 24.0) vs. 12.0 (8.0, 15.0), PCT (μg/L): 3.48 (1.01, 26.70) vs. 2.45 (0.32, 15.65); death group vs. survival group in 60 days: SOFA score: 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 9 (6, 14) vs. 6 (6, 9), LODS score: 4.0 (1.0, 5.0) vs. 1.0 (0, 2.0), APACHEⅡ score: 16.5 (12.0, 20.0) vs. 12.0 (8.0, 15.0), PCT (μg/L): 2.67 (0.98, 17.73) vs. 2.22 (0.31, 16.75); all P < 0.05]. ROC curve showed that: ① the area under ROC curve (AUC) of PCT in the diagnosis of IAI induced sepsis with single bacterial infection was 0.740 [95% confidence interval (95% CI) was 0.648-0.833]. When the optimal cut-off value of PCT was 1.82 μg/L, the sensitivity of diagnosis of G - bacterial infection was 74.0%, and the specificity was 68.2%. When PCT value was higher than 10.92 μg/L, the specificity of diagnosis of G - bacterial infection could reach 81.8%. ② In the prediction of 28-day and 60-day mortality for septic patients with BSI induced by IAI, the APACHEⅡ score achieved the highest AUC [28 days: 0.791 (95% CI was 0.680-0.902), 60 days: 0.748 (95% CI was 0.645-0.851)]. APACHEⅡ score higher than 14.5 could help to predict 28-day and 60-day mortality for IAI patients with negative predictive values of 94.9% and 88.5%. However, the predictive value of PCT for septic patients with BSI induced by IAI was relatively lower [28-day AUC: 0.610 (95% CI was 0.495-0.725), 60-day AUC: 0.558 (95% CI was 0.450-0.667)]. Conclusion:PCT is more reliable in the identification of pathogen type among IAI induced sepsis with BSI, while APACHEⅡ score may perform better in predicting early and late mortality.
ABSTRACT
Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.
Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.
Subject(s)
Humans , Pain, Postoperative/drug therapy , Surgical Wound Infection/drug therapy , Peritoneal Lavage , Laparoscopy , Colectomy/methods , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Gentamicins/therapeutic use , Double-Blind Method , Saline Solution/therapeutic use , Length of StayABSTRACT
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
INTRODUCTION@#The World Society of Emergency Surgery (WSES) recently developed and validated a sepsis severity score for complicated intra-abdominal infections (cIAIs). We aimed to prospectively study the validity of this score in our local setting and compare it with global findings.@*METHODS@#In a prospective study of 100 consecutive adult patients with cIAIs treated at Al-Ain Hospital, United Arab Emirates, from October 2014 to January 2016, we studied patients' demographics, disease, risk factors, WSES Sepsis Severity Score, management, hospital stay and mortality. Our findings were compared with those from a recent global multicentre prospective study from 53 countries (n = 4,496).@*RESULTS@#Compared with global data, our patients were more likely to be male (p < 0.0001) and younger (p < 0.0001), with more appendicitis and perforated peptic ulcers (p < 0.0001), significantly lower sepsis severity score (p < 0.0001) and more delays in surgical intervention (p = 0.001). Nevertheless, they had similar adequate source control (p = 0.54) and surgical reinterventions (p = 0.63). Overall, our patients had a significantly lower mortality rate (1.0% vs. 9.3% in global data; p = 0.001). A direct logistic regression model showed that the WSES Sepsis Severity Score significantly predicted mortality (p < 0.0001), but our hospital's setting was not predictive of mortality compared with other hospitals (p = 0.18).@*CONCLUSION@#Although our patient demographics and hospital's setting significantly differed from those of other international hospitals, the WSES Sepsis Severity Score was very accurate in predicting mortality among our patients, which supports its generalisability for all patient populations worldwide.
ABSTRACT
Objective@#To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection.@*Methods@#The prospective study was conducted. The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People′s Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected. All patients were randomly divided into two groups by the envelope method with double-blind technique, including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group. Observation indicators: (1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups; (2) postoperative conditions in the two groups; (3) follow-up. Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and intra-group comparison and comparison between groups were analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test.@*Results@#Sixty-two patients were screened for eligibility, including 38 males and 24 females, aged (54±14)years, with the range of 22-81 years. There were 30 in the eco-immune group and 32 in the control group. (1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups: before treatment, the percentages of CD3+, CD4+, CD8+, ratio of CD4+ /CD8+, count of natural killer (NK) cells, levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61%±12%, 34%±5%, 28%±5%, 1.25±0.34, 17.26%±2.74%, (2.4±0.3)ng/L, and (1.7±0.5)g/L, versus 59%±11%, 33%±5%, 27%±4%, 1.27±0.36, 16.96%±2.99%, (2.5±0.5)ng/L, (1.8±0.5)g/L for the control group, respectively, there were no significant differences between the two groups (t=-0.563, -0.354, -0.987, 0.327, -0.462, 0.887, 0.991, P>0.05). After 7 days of treatment, the above indices for the eco-immune group were 62%±8%, 37%±6%, 27%±8%, 1.45±0.32, 22.63%±7.25%, (2.2±0.4)ng/L, and (2.3±0.4)g/L, versus 58%±8%, 32%±4%, 27%±6%, 1.26±0.22, 16.26%±2.10%, (2.7±0.6)ng/L, and (2.0±0.4)g/L for the control group, respectively, there were significant differences in the percentages of CD3+, CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA (t=-2.393, -4.336, -3.074, -5.338, 4.010, -3.155, P<0.05), but no significant difference in the percentage of CD8+ between the two groups (t=0.077, P>0.05). In the eco-immune group, the percentage of CD4+, ratio of CD4+ /CD8+, count of NK cells, levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t=-2.899, -2.739, -4.385, 2.157, -5.788, P<0.05), but the percentages of CD3+ and CD8+ showed no significant differences after 7 days of treatment (t=-0.490, 1.193, P>0.05). In the control group, the percentage of CD8+ and level of IgA showed significant differences after 7 days of treatment (t=3.659, -2.258, P<0.05), but the percentage of CD4+, ratio of CD4+ /CD8+, count of NK cells, and level of blood endotoxin showed no significant differences after 7 days of treatment (t=0.157, 0.759, 1.132, 1.212, -0.532, P>0.05). (2) Postoperative conditions in the two groups: the time to first flatus and duration of postoperative hospital stay of the eco-immune group were (2.4±0.5)days and (8±4)days, respectively, versus (2.9±0.7)days and (11±7)days of the control group; there were significant differences in the above indices between the two groups (t=-3.017, -2.764, P<0.05). In the eco-immune group, the incidence of complication was 6.7%(2/30), including 1 case of wound infection, 1 case of pulmonary infection. In the control group, the incidence of complication was 31.2%(10/32), including 6 cases of wound infection, 2 cases of pulmonary infection, 1 case of intra-abdominal infection, and 1 case of systemic inflammatory response syndrome. There was a significant difference in the incidence of complication between the two groups (χ2=4.122, P<0.05). The patients with infection were recovered after corresponding systematic conservative treatments. (3) Follow-up: of the 62 patients, 46 were followed up for 3-9 months, with a median follow-up time of 6 months, including 26 in the eco-immune group and 20 in the control group. During the follow-up, no complication or infection recurred in the two groups.@*Conclusion@#Compared with simple enteral nutrition, early postoperative enteral eco-immune nutrition in the nutritional support treatment is safe and effective for patients with intra-abdominal infection, which can enhance the immune function of patients, shorten the recovery time of patients, and reduce the incidence of infection complications.
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
Objective To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection.Methods The prospective study was conducted.The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People's Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected.All patients were randomly divided into two groups by the envelope method with double-blind technique,including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group.Observation indicators:(1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups;(2) postoperative conditions in the two groups;(3) follow-up.Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019.Measurement data with normal distribution were represented as Mean ± SD,and intra-group comparison and comparison between groups were analyzed using the t test.Count data were represented as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Results Sixty-two patients were screened for eligibility,including 38 males and 24 females,aged (54± 14)years,with the range of 22-81 years.There were 30 in the eco-immune group and 32 in the control group.(1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups:before treatment,the percentages of CD3+,CD4+,CD8+,ratio of CD4+/CD8+,count of natural killer (NK) cells,levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61％ ± 12％,34％ ± 5％,28％ ± 5％,1.25 ± 0.34,17.26％±2.74％,(2.4±0.3)ng/L,and (1.7±0.5)g/L,versus 59％±11％,33％±5％,27％±4％,1.27± 0.36,16.96％ ±2.99％,(2.5± 0.5) ng/L,(1.8± 0.5) g/L for the control group,respectively,there were no significant differences between the two groups (t =-0.563,-0.354,-0.987,0.327,-0.462,0.887,0.991,P＞ 0.05).After 7 days of treatment,the above indices for the eco-immune group were 62％±8％,37％±6％,27％± 8％,1.45±0.32,22.63％±7.25％,(2.2±0.4) ng/L,and (2.3±0.4) g/L,versus 58％±8％,32％±4％,27％ ±6％,1.26±0.22,16.26％±2.10％,(2.7±0.6)ng/L,and (2.0±0.4)g/L for the control group,respectively,there were significant differences in the percentages of CD3+,CD4+,ratio of CD4+/CD8+,count of NK cells,levels of blood endotoxin and IgA (t =-2.393,-4.336,-3.074,-5.338,4.010,-3.155,P＜0.05),but no significant difference in the percentage of CD8+ between the two groups (t =0.077,P＞0.05).In the coo-immune group,the percentage of CD4+,ratio of CD4+/CD8+,count of NK cells,levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t =-2.899,-2.739,-4.385,2.157,-5.788,P＜0.05),but the percentages of CD3+ and CD8+ showed no significant differences after 7 days of treatment (t =-0.490,1.193,P＞ 0.05).In the control group,the percentage of CD8+ and level of IgA showed significant differences after 7 days of treatment (t=3.659,-2.258,P＜0.05),but the percentage of CD4+,ratio of CD4+/CD8+,count of NK cells,and level of blood endotoxin showed no significant differences after 7 days of treatment (t =0.157,0.759,1.132,1.212,-0.532,P＞0.05).(2) Postoperative conditions in the two groups:the time to first flatus and duration of postoperative hospital stay of the eco-immune group were (2.4± 0.5) days and (8± 4) days,respectively,versus (2.9±0.7)days and (11±7)days of the control group;there were significant differences in the above indices between the two groups (t =-3.017,-2.764,P＜0.05).In the eco-immune group,the incidence of complication was 6.7％(2/30),including 1 case of wound infection,1 case of pulmonary infection.In the control group,the incidence of complication was 31.2％ (10/32),including 6 cases of wound infection,2 cases of pulmonary infection,1 case of intra-abdominal infection,and 1 case of systemic inflammatory response syndrome.There was a significant difference in the incidence of complication between the two groups (x2=4.122,P＜ 0.05).The patients with infection were recovered after corresponding systematic conservative treatments.(3) Follow-up:of the 62 patients,46 were followed up for 3-9 months,with a median follow-up time of 6 months,including 26 in the eco-immune group and 20 in the control group.During the follow-up,no complication or infection recurred in the two groups.Conclusion Compared with simple enteral nutrition,early postoperative enteral eco-immune nutrition in the nutritional support treatment is safe and effective for patients with intra-abdominal infection,which can enhance the immune function of patients,shorten the recovery time of patients,and reduce the incidence of infection complications.
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
Objective To investigate the microbiological epidemiology and clinical use of antibiotics in patients complicated intra-abdominal infection (cIAI),therefore to optimize antibiotic use and to promote antimicrobial stewardship.Methods A total of 451 patients with cIAI from a Chinese tertiary hospital between January 2015 and December 2016 were retrospectively reviewed.The infection severity,timing of microbiological specimen sampling,culture results,initial antibiotic selection and later anti-infective regimen adjustment were analyzed.Results Three hundred and sixteen (70.1％,316/451) patients undergone microbiological investigation at infection sites within 3 days and 133 (42.1％) patients had a positive culture,of which 64.5％ were Enterobacteriaceae.Three hundred seventy-four patients (82.9％) initially received broad-spectrum antibiotics against gram-negative bacilli.Sixty-five patients (14.4％) initially received combined antibiotic therapy,of which 30.8％ were deemed as overuse.Among 308 patients who initially received broad-spectrum antibiotic therapy,268 patients (87.0％) clinically improved in five days,while de-escalation was only conducted in 72 cases (26.9％).On average,patients were treated with (2.29±1.30) antibiotics for a duration of (10.6±6.5) days,and 42.4％ received combined antibiotic therapy during hospitalization.Conclusions The major microbiological pathogens in cIAI patients in our hospital were Enterobacteriaceae.However,there are phenomena such as excessive usage with broad-spectrum antibiotics,insufficient awareness of de-escalation,and long course of anti-infective therapy,which needs to be further improved.
ABSTRACT
Objective To investigate the distribution of pathogens and the results of drug sensitivity test in patients with intra-abdominal infection, and to provide theoretical basis for the rational selection of anti-infective programs. Methods The pathogenic bacteria culture and drug sensitivity test results of peritoneal fluid or drainage fluid in hospitalized patients with intra-abdominal infection were retrospectively analyzed. Results 405 cases of positive culture results were obtained in 3 509 cases of intra-abdominal infection specimens. A total of 436 strains of pathogens, including 268 strains of Gram-negative bacteria (61.47％), 151 strains of Gram-positive bacteria(34. 63％), 17 strains of Fungi (3. 90％). The top five were Escherichia coli (22. 25％), Acinetobacter baumannii (10. 09％), Klebsiella pneumoniae (9. 86％), Enterococcus faecium (7. 80％), Staphylococcus aureus(4. 13％). The extended spectrum β-lactamas rates of Escherichia coli and Klebsiella pneumoniae were 58. 76％ and 16. 28％, respectively. The multi-drug resistant strains of Acinetobacter baumannii were 79. 55％. Vancomycin resistant strains were detected in Enterococcus faecium (8. 82％), the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) in Staphylococcus aureus was 72. 22％, and the detection rate of methicillin-resistant Staphylococcus aureus (MRCNS) in coagulase-negative Staphylococci was 51. 92％. Conclusion The main pathogens of intra-abdominal infection is Escherichia coli, followed by Acinetobacter baumannii, Klebsiella pneumoniae, Enterococcus faecium and Staphylococcus aureus, the detection rate of MRSA and MRCNS is high. The overall drug resistance of intra-abdominal infection is serious.
ABSTRACT
Objective To investigate the epidemiological and etiological characteristics of gram-negative bacilli (GNB) isolated from patients with intra-abdominal infection (IAI). Methods The patients with abdominal infection were identified retrospectively during the period from 2011 to 2015. The clinical and microbiological data were analyzed by WHONET 5.6 and SPSS 20.0. Results A total of 478 cases of IAI [hospital-acquired (HA) 290 cases, community-acquired (CA) 188 cases] were included in this analysis. CA-IAI patients at low risk were associated with significantly better outcome, and lower acute physiology and chronic health evaluation (APACHE) Ⅱ score and sequential organ failure assessment (SOFA) score than the CA-IAI and HA-IAI patients at high risk. The most common gram-negative bacillus isolated from intra-abdominal infections was E. coli and K. pneumoniae. The prevalence of ESBLs-producing E. coli and K. pneumoniae isolates was 75.8％ and 35.8％, respectively. The E. coli isolates remained highly susceptible to amikacin, piperacillin-tazobactam, and carbapenems during the 5-year period, while the K. pneumoniae isolates showed poorer susceptibility to ampicillin-sulbactam. Conclusions The prevalence of ESBLs-producing GNB is increasing in the patients with IAI. Such isolates were resistant to commonly used antimicrobial agents, but generally susceptible to carbapenems. It is important to strengthen the monitoring of antimicrobial resistance in IAIs, and choose antimicrobial therapy rationally based on the results of antimicrobial susceptibility test.
ABSTRACT
Objective: To share the anti-infection experience for the patients with complicated intra-abdominal infection after operation.Methods: The whole course of drug administration participated by clinical pharmacist in one patient with complicated intra-abdominal infection after pancreatoduodenectomy were retrospectively analyzed and discussed.Results: Enterococcus was found in the blood culture and ascites.According to the results of drug sensitive tests, clinical pharmacist provided medication suggestions and performed medication mornitoring.According to the blood concentration, clinical pharmacist adjusted the dose of vancomycin, and changed the therapy regimen according to the changes of conditions.As a result, adverse reactions were controlled timely, and satisfactory treatment effects were obtained.Conclusion: The aetiology of complicated intra-abdominal infection is complex with intractable treatment, and the participation of clinical pharmacists in the treatment can improve the efficiency and safety.
ABSTRACT
Objective To understand the pathogenic characteristics of intra-abdominal infection after appendecto-my in patients with appendicitis.Methods Clinical data of patients undergoing appendectomy in a hospital from January 2013 to December 2015 were analyzed retrospectively,pathogenic characteristics,treatment,and prognosis of patients with intra-abdominal infection were analyzed.Results A total of 431 patients undergoing appendectomy were investigated,38 (8.82%)developed intra-abdominal infection.36 strains of pathogenic bacteria were isolated, 34 (94.44%)of which were gram-negative bacteria,mainly Escherichiacoli(n=29,80.55%);2 (5.56%)strains were gram-positive bacteria,1 of which was Staphylococcusaureus,and the other was Enterococcusavium.The re-sistance rates of 29 strains of Escherichia coli to commonly used antimicrobial agents (amoxicillin,piperacillin,ti-carcillin,cefuroxime,ceftazidime,and cefalotin)were 72.41%-93.10%,none of strains were found to be resistant to piperacillin/tazobactam,meropenem,imipenem,and amikacin.Conclusion Escherichiacoli is the most common pathogen causing intra-abdominal infection after appendectomy and it has high resistance rates to most commonly used antimicrobial agents,piperacillin/tazobactam,amikacin,and carbapenems are recommended for treating intra-abdominal infection after appendectomy.
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.