Effects of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection in mainland China: a meta-analysis

SUMMARY OBJECTIVE: The aim of this study was to explore the efficacy of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection in mainland China using meta-analysis. METHODS: We searched China National Knowledge Network, Wanfang Medical Network, Chinese Science Citation Database, PubMed, and Embase Databases for publications of imipenem combined with glutamine in the treatment of severe acute pancreatitis abdominal infection. The search time limit was from the establishment of the database to April 10, 2021. Stata software version 12.0 was used for statistical analysis; the combined effect size odds ratio and standardized mean difference values were calculated for the count data and measurement data, respectively; and the heterogeneity test was performed in this study. RESULTS: A total of five randomized controlled trials were included. A total of 499 cases were included, with 251 in the observation group and 248 in the control group. Meta-analysis results showed that the efficacy of imipenem combined with glutamine in the treatment of severe acute pancreatitis with abdominal infection was significantly better than that of imipenem alone (odds ratio=0.78, 95%CI 0.71-0.86, p=0.040). CONCLUSION: Imipenem combined with glutamine can significantly improve the efficacy in the treatment of severe acute pancreatitis with abdominal cavity infection.

Perfil clínico, quirúrgico y epidemiológico de pacientes reintervenidos / Clinical, Surgical and Epidemiological Profile of Reintervened Patients

Introducción: Los pacientes reintervenidos quirúrgicamente no se han caracterizado en el Hospital "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba. Objetivo: Caracterizar a los pacientes reintervenidos quirúrgicamente según variables de interés. Métodos: Se realizó un estudio transversal, descriptivo y retrospectivo de los pacientes reintervenidos en el citado hospital durante el trienio 2018-2020. La muestra fue de 6279 enfermos. Se analizaron variables epidemiológicas y clínicas quirúrgicas de interés. Los datos se resumieron mediante análisis de frecuencias. Resultados: La tasa de reintervenciones fue de 1,7 por ciento respecto al total de operaciones mayores y el 1,6 por ciento correspondió a la cirugía abdominal. Predominó el grupo de edades entre 46 y 60 años y el sexo femenino con 37,8 por ciento y 55 por ciento, respectivamente. La operación inicial fue realizada de urgencia en el 91 por ciento de los casos por apendicitis aguda y oclusión intestinal (21,7 por ciento y 18 por ciento). El 70,2 por ciento de la casuística se reintervino 4 días después por absceso intrabdominal (39,6 por ciento) y dehiscencia de sutura anastomótica (20,7 por ciento). La relaparotomía a demanda (98,1 por ciento) fue la mayormente efectuada con 18 por ciento de aplicación de la técnica de abdomen abierto. La mortalidad fue de 28 por ciento y la causa de muerte fue el choque séptico en un 80,6 por ciento. Conclusiones: Los pacientes reintervenidos constituyeron un problema de salud hospitalario que impactó en el perfil de morbilidad y mortalidad de la cirugía abdominal(AU)

Introduction: Surgical reintervention patients have not been characterized at Dr. Ambrosio Grillo Portuondo Hospital of Santiago de Cuba. Objective: To characterize the surgically intervened patients according to variables of interest. Methods: A cross-sectional, descriptive and retrospective study was carried out with the patients surgically reintervened in the aforementioned hospital during the 2018-2020 triennium. The sample consisted of 6279 patients. Epidemiological and surgical-clinic variables of interest were analyzed. Data were summarized by frequency analysis. Results: The reintervention rate was 1.7 percent compared to the total number of major operations, while 1.6 percent corresponded to abdominal surgery. There was a predominance of the age group 46-60 years and the female sex predominated, accounting for 37.8 percent and 55 percent, respectively. The initial operation was performed urgently in 91 percent of the cases, due to acute appendicitis and intestinal occlusion, accounting for 21.7 percent and 18 percent, respectively. 70.2 percent of the cases were reintervened four days later for intraabdominal abscess (39.6 percent) and anastomotic suture dehiscence (20.7 percent). On-demand relaparotomy (98.1 percent) was the most performed procedure, with 18 percent of application of the open-abdomen technique. Mortality represented 28 percent of cases, while the most frequent cause of death was septic shock, accounting for 80.6 percent of deaths. Conclusions: The reintervened patients constituted a hospital health concern that impacted on the morbidity and mortality profile of abdominal surgery(AU)

Algunas consideraciones necesarias sobre la infección intraabdominal posoperatoria

RESUMEN La infección intraabdominal posoperatoria, es un problema de salud a escala mundial y precisa de atención multidisciplinaria para corregirla. Su complejidad radica en el diagnóstico precoz y la relaparotomía para controlarla. Es una complicación de la cirugía abdominal, cuya atención clínico quirúrgica integral compete a cirujanos generales, cirujanos pediátricos, obstetras, proctólogos, urólogos, imagenólogos, anestesiólogos e intensivistas. Se impone por tanto en los médicos tratantes, el dominio de aspectos esenciales, como parte de la superación profesional permanente y continuada que les permita garantizar la necesaria calidad atencional del afectado, como única vía para disminuir las altas tasas de morbilidad y mortalidad debido a esta temida afección.

ABSTRACT Postoperative intra-abdominal infection is a global health problem and requires multidisciplinary care to correct it. Its complexity lies in the early diagnosis and relaparotomy to control it. It is a complication of abdominal surgery, whose comprehensive clinical surgical care is the responsibility of general surgeons, pediatric surgeons, obstetricians, proctologists, urologists, imaging specialists, anesthesiologists, and intensivists. Therefore, the mastery of essential aspects is necessary on the treating doctors, as part of the permanent and continuous professional improvement that allows them to guarantee the necessary quality of care of the affected, as the only way to reduce the high rates of morbidity and mortality due to this dreaded condition.

Infección intraabdominal posoperatoria tratada con técnica de abdomen abierto desde un enfoque inclusivo / Infecção intra-abdominal pós-operatória tratada com uma técnica de abdômen aberto a partir de uma abordagem inclusiva / Postoperative intraabdominal infection treated with open abdominal technique from an inclusive approach

Introducción: La infección intraabdominal posoperatoria es una grave complicación que con frecuencia requiere de la técnica de abdomen abierto para solucionarla, lo cual exige competencia profesional y humanismo. Objetivo: Analizar desde un enfoque inclusivo las particularidades de la técnica de abdomen abierto aplicada en pacientes con infección intraabdominal posoperatoria. Método: Se realizó un estudio exploratorio con enfoque cualitativo en el Hospital Clínico Quirúrgico Dr. Ambrosio Grillo Portuondo de Santiago de Cuba durante junio-octubre de 2020. Se utilizó la sistematización como método teórico y como métodos empíricos el análisis documental con la revisión de las historias clínicas y la observación con la práctica atencional-docente de la autora. Resultados: El análisis documental y la práctica contextualizada de la autora en los diversos escenarios de atención clínico-quirúrgica a pacientes con infección intraabdominal posoperatoria permitió constatar la necesidad de que el cirujano no vea de forma aislada al paciente con esta grave complicación a quien se le aplica con frecuencia la técnica de abdomen abierto para controlar la contaminación, ya que las particularidades de esta estrategia demandan la actualización sistemática para mejorar el desempeño profesional unido a una gran sensibilidad humana. Conclusiones: En la infección intraabdominal posoperatoria tratada con técnica de abdomen abierto es pertinente que los médicos responsables muestren dominio de las particularidades de la estrategia quirúrgica con un enfoque inclusivo unido a una gran sensibilidad humana como evidencia de calidad atencional(AU).

Introduction: Postoperative intraabdominal infection is a serious complication that commonly requires the open abdominal technique to solve it, and also requires of professional competence and humanism. Objective: To assess, from an inclusive approach, the features of the open abdominal technique applied in patients with postoperative intraabdominal infection. Method: An exploratory study with a qualitative approach was carried out at the Hospital Clínico Quirúrgico Dr. Ambrosio Grillo Portuondo in Santiago de Cuba, from June thoughout October 2020. Systematization was used as theoretical method and, on the other hand, documentary analysis (applying the clinical histories review) and the observation (applying the author's care-teaching practice) were used as empirical methods. Results: The documentary analysis and the contextualized practice of the author, in the different scenarios of clinical-surgical care to patients with postoperative intraabdominal infection, allowed confirming the need for the surgeon not to see patients with this serious complication as an isolated event. Patients who open abdomen technique were frequently applied to control contamination. It should be taken into account that the particularities of this strategy demand for systematic updating to improve professional performance matched with a great human sensitivity. Conclusions: In the postoperative intraabdominal infection treated with open abdominal technique, it is pertinent that physicians show mastery concerning surgical strategy features with an inclusive approach matched with a great human sensitivity as evidence of a great quality care(AU).

Introdução: A infecção intra-abdominal pós-operatória é uma complicação grave que frequentemente requer a técnica de abdômen aberto para sua resolução, o que requer competência profissional e humanismo. Objetivo: Analisar a partir de uma abordagem inclusiva as particularidades da técnica de abdome aberto aplicada em pacientes com infecção intra-abdominal pós-operatória. Método: Foi realizado um estudo exploratório com abordagem qualitativa no Hospital Clínico Quirúrgico Dr. Ambrosio Grillo Portuondo de Santiago de Cuba durante o período de junho a outubro de 2020. A sistematização foi utilizada como método teórico e como método empírico, o documentário análise com a revisão do prontuário e observação com a prática pedagógica do autor. Resultados: A análise documental e a prática contextualizada do autor nos diversos ambientes de atendimento clínico-cirúrgico ao paciente com infecção intra-abdominal pós-operatória permitiram constatar a necessidade de o cirurgião não atender isoladamente o paciente portador dessa grave complicação. A técnica do abdômen aberto é frequentemente aplicada para o controle da contaminação, uma vez que as particularidades dessa estratégia requerem atualização sistemática para melhorar o desempenho profissional aliado a grande sensibilidade humana. Conclusões: No pós-operatório de infecção intra-abdominal tratada pela técnica de abdome aberto, é pertinente que os médicos responsáveis demonstrem domínio das particularidades da estratégia cirúrgica com abordagem inclusiva aliada a grande sensibilidade humana como evidência de qualidade da assistência(AU).

Pacientes con infección intrabdominal en la unidad de cuidados intensivos / Patients with Intrabdominal Infection in the Intensive Care Unit

RESUMEN Los pacientes con infección intrabdominal en unidad de cuidados intensivos representan un reto diagnóstico y terapéutico, tanto en el mundo como en Cuba y es responsable del aumento de un periodo de invalidez transitoria y de mortalidad de una parte de los pacientes. El objetivo del artículo fue profundizar en los conocimientos actuales sobre el tratamiento de la infección intrabdominal en la unidad de cuidados intensivos. Se realizó revisión tipo exploratorio-descriptivo para profundizar el tema y se consultaron fuentes primarias y secundarias de información de las bases de datos Scopus, Medline, Cochrane, Hinary y Redalyc bajo los criterios de sus revisores. La infección intrabdominal en los pacientes bajo cuidados intensivos suscita un mal pronóstico, por lo que requiere de un diagnóstico oportuno y un tratamiento eficaz. Los índices de mortalidad en estos enfermos apenas han decrecido a pesar de los avances tecnológicos(AU)

ABSTRACT Patients with intraabdominal infection in the intensive care unit represent a diagnostic and therapeutic challenge, both in Cuba and worldwide. Such condition is responsible for the increase in the period of temporary disability and mortality in part of the patients. The aim of the article was to deepen the current knowledge on treatment of intraabdominal infection in the intensive care unit. An exploratory-descriptive review was carried out to deepen the subject and primary and secondary sources of information were consulted from the Scopus, Medline, Cochrane, Hinary and Redalyc databases, following the criteria of their reviewers. Intraabdominal infection in patients under intensive care presents poor prognosis, which requires prompt diagnosis and effective treatment. Mortality rates in these patients have barely decreased despite technological advances(AU)

Hallazgos microbiológicos y susceptibilidad antimicrobiana en cirugía abdominal de urgencia / Microbiological findings and antimicrobial susceptibility in emergency abdominal surgery

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Retrospective study on the risk factors related to intraabdominal infection after anatomical hepatectomy / 中华普通外科杂志

Objective@#To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.@*Methods@#The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed. The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused, intraoperative estimated blood loss, volume of blood transfusion, the dosage of vasoactive drugs, postoperative liver function, inflammation index, the incidence of intraabdominal infection and the length of hospital stay (LOS).@*Results@#Patients were divided into infection group (n=39) and non- infection group (n=83). Intraabdominal infection was correlated with preoperative cirrhosis, the elevated direct bilirubin and alanine aminotransferase, the duration of operation, bilioenteric anastomosis or cholangiotomy, the infusion volume of colloid and crystalloid fluid, transfusion volume, direct bilirubin level on the POD 1(post-operation on day 1) (P<0.05); Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P<0.05).@*Conclusions@#Intraoperative infused volume of synthetic colloid, along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.

Retrospective study on the risk factors related to intraabdominal infection after anatomical hepatectomy / 中华普通外科杂志

Objective To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.Methods The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed.The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused,intraoperative estimated blood loss,volume of blood transfusion,the dosage of vasoactive drugs,postoperative liver function,inflammation index,the incidence of intraabdominal infection and the length of hospital stay (LOS).Results Patients were divided into infection group (n =39) and non-infection group (n =83).Intraabdominal infection was correlated with preoperative cirrhosis,the elevated direct bilirubin and alanine aminotransferase,the duration of operation,bilioenteric anastomosis or cholangiotomy,the infusion volume of colloid and crystalloid fluid,transfusion volume,direct bilirubin level on the POD 1 (post-operation on day 1) (P ＜ 0.05);Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P ＜ 0.05).Conclusions Intraoperative infused volume of synthetic colloid,along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.

Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery

PURPOSE: Anastomotic leakage (AL) is a type of intra-abdominal infection (IAI) which requires appropriate antibiotics with proper intervention. This study aimed to improve the appropriateness of antibiotic treatment by assessing the patterns of antibiotic treatment and resistance of pathogen profiles in patients who had AL after colorectal cancer surgery.METHODS: From June 2006 through December 2017, the medical records of the patients who had AL after elective abdominal surgery for colorectal cancer in Kyung Hee University Hospital at Gangdong, Seoul, Korea were reviewed retrospectively. Baseline characteristics and consistence of antibiotics with culture study results were analyzed to evaluate the appropriateness of treatment.RESULTS: Among 982 patients who underwent primary surgery for colorectal cancer, 41 (4.2%) had AL. Mean time of diagnosis of AL from surgery was 6.3 days. The most commonly used prophylactic antibiotics for the primary surgery was 2nd generation cephalosporin (66.6%). Mean duration of prophylactic antibiotics usage was 2.8 days. The most commonly used empirical antibiotics after AL occurred was piperacillin and tazobactam (32.6%). Mean duration of empirical antibiotics usage was 8.2 days. The most commonly identified pathogens were Escherichia coli and Enterococci spp. (26.8% each), and 12.2% of the “ESKAPE” pathogens were identified. Resistance to empirical antibiotics was 45.5% (10/22).CONCLUSION: Penetration of culture study for AL after colorectal cancer surgery appeared relatively low, although the profile of pathogens isolated from the AL patients can give important clues and evidence for appropriate antibiotics use. Surgeons should pay attention in performing culture studies for IAI including AL for proper patient treatment.

Microbiota Evaluation and Extracellular Cytokine Profile in Patients Affected with Intraabdominal Infection.

Failures in the control of infectious focus may be associated with Intra-abdominal infections (IAI)-driven sepsis. We evaluated the bacterial antimicrobial profile and the cytokine production in patients with IAI in Belo Horizonte, Brazil. To the analyses, Vitek 2 bioMérieux and BD-CBA Human Inflammatory Cytokines were used. Escherichia coli, Enterococcus faecalis and Bacteroides fragilis were predominant in this cohort. Enterobacteriaceae was resistant to at least 4 different antimicrobial classes and 80.0% of Acintobacter baumannii strains to imipenem. 81.8% of Staphylococcus spp. were methicillin-resistant. Penicillin and clindamycin resistance were found in 80.0% and 26.7% of anaerobes, respectively. IL-8 was found in all IAI secretions and in 93.5% of analyzed sera; while IL-6 was identified in 93.5% of patient’s serum and in 51.6% analyzed secretions. IL-10 was detected in 53.3% of patient’s serum. Our data indicates the relevance of further cytokine profile studies to better understanding the evolution of these processes.

Open abdomen management for severe intraabdominal infection / 中华消化外科杂志

The traditional management of severe intraabdominal infection include source control and antibiotics application.Fluid resuscitation and open abdomen management are recent development in the treatment of severe intraabdominal infection.The overall morbidity of severe intraabdominal infection was decreased under 20％ by these comprehensive treatment.Because of edema,inflammation and gastrointestinal dysfunction,the intraabdominal pressure was increased,the peritoneal infusion pressure was decreased and the perfusion was insufficient,and leaving abdomen open can reverse these condition,and is helpful for debridement and drainage of the source of infection,as well as management of bleeding and intestinal fistula.Entero-atmospheric fistula is the main severe complication after open abdomen,and it should be prevented by temporary abdominal closure and early closure of the wound.

A Randomized, Controlled, Open, Multi-Center Clinical Trial Comparing Ertapenem versus Ceftriaxone plus Metronidazole for the Treatment of Complicated Intra-abdominal Infections in Adults

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.

A Randomized, Controlled, Open, Multi-Center Clinical Trial Comparing Ertapenem versus Ceftriaxone plus Metronidazole for the Treatment of Complicated Intra-abdominal Infections in Adults

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.