Basic principles, controversy and consensus on the use of antibiotics in the treatment of abdominal infection / 中国实用外科杂志

Complicated intra-abdominal infections(cIAIs)remain a majorchallenge in clinical practice.In addition to significant morbidity and mortality for patients,they consume substantial hospitalresources.It is compounded by the aging of thepopulation and the burden of chronic disease in these patients,as well as the increased prevalence of resistantbacteria in both the healthcare setting and the community.Besides timely effective source control and fluid resuscitation,rational use of antimicrobials isanintegral part of good clinical practice.Once cIAIs are suspected or diagnosed,anti-infective treatment should be given as soon as possible.At this time,empirical antiinfective treatment is particularly important due to the lack of microbial culture and drug susceptibility results.In the process of anti-infective treatment,the application of anti-infective drugs can be adjusted according to the culture of pathogens and the results of drug sensitivity experiments.

Escalation surgical therapy approaches for complicated intra-abdominal infection / 中国实用外科杂志

Complicated intra-abdominal infections(cIAIs)is always associated with high mortality,invasive open surgery cannot improve patients' prognosis.With the spread of the concept of minimally invasive surgery(MIS)and damage control surgery(DCS),the authors propose the escalation surgical therapy approaches to better manage cIAIs with less operative damange.These approaches include minimally invasive drainage(percutaneous drainage,endoscopic drainage),MIS(minimally invasive operative drainage,enterostomy)and open surgery(relaparotomy on demand,planned relaparotomy,open abdomen).These treatments cause increasing trauma stress,longer recovery period and higher morbidity rates to patients successively.Due to the increased use of planned relaparotomy in treating cIAIs,abdominal packing and open abdomen were applied more frequently.However,the prevention of open abdomen-associated morbidies,including enterocutaneous fistula and abdominal wall defect,should be paid attention to.In clinical practice,use of escalation surgical therapy approaches to treat cIAIs is not fixed,doctors should choose appropriate management according to patients' conditions.Meanwhile,good resuscitation,appropriate choice of antibiotics and nutritional support are essential to improve the outcome of patients with cIAIs.

Effects of tigecycline on immune function in patients with complicated abdominal infection / 安徽医科大学学报

Objective To study the effects of tigecycline on immune function in patients with complicated intra-abdominal infections (cIAI). Methods A total of 24 cIAI patients received treatment of tigecycline, and then the effects of tigecycline on level of peripheral blood monouclear cells (PBMC) proliferation, concentration of inflammatory cytokines, and expression of CD3, CD4 and CD8 were investigated. Results The total effective rates of tigecycline were 70. 8％. Tigecycline treatment significantly reduced proliferative level of PBMC, decreased the levels of interleukin-1β (IL-1β), IL-6 and IL-8 in supernatants of PBMC cultures as well as serum. Moreover, tigecycline therapy significantly up-regulated the percentage of CD3 + and CD4 +, increased the ratio of CD4+ / CD8 +, and down-regulated percentage of CD8 + in peripheral blood. Conclusion Tigecycline could regulate immune function in cIAI patients.

Nutritional support therapy in complicated intra-abdominal infection / 中华消化外科杂志

Complicated intra-abdominal infections (cIAIs) are common clinical conditions but difficult to manage in abdominal surgical practice.Since usually combined with gastrointestinal dysfunction,nutritional support therapy plays a key role in the long-term treatment.Early enteral nutrition could maintain intestinal barrier function,regulate immune function,and reduce gut permeability and bacterial translocation.Enteral combined with supplement parenteral nutrition could provide full-energy support to improve negative nitrogen balance and physiological function.Underlying pathophysiological changes should be understood,and appropriate mode of nutritional support should be chose carefully during disease course which can reduce incidence of complications and improve patients' prognoses.

Efficacy and safety of tigecycline on patients with complicated intra-abdominal infections / 中国生化药物杂志

Objective To investigate the clinical effect and safety of tigecycline on in patients with complicated intra-abdominal infections. Methods 52 cases of patients with complicated intra-abdominal infection were selected and randomly divided into 2 groups.26 cases in the control group were given routine anti-infection treatment, and 26 cases in the treatment group were treated with conventional anti-infection combined with tigecycline.The CD molecules and NK cell level, serum lactate and procalcitonin levels, and the clinical efficacy and safety were compared after the treatment between two groups.Results The effective rate of control group ( 69.23%) was lower than the treatment group ( 92.31%) with statistical significance (P<0.05), the levels of CD3 +, CD4 +/CD8 +, CD4 +and NK cells of the treatment group after treatment were higher than the control group, the level of CD8 +was lower than the control group after treatment, procalcitonin and serum lactate levels were lower than the control group, with statistical significance ( P<0.05 ) , there was no difference in adverse reactions between the two groups.Conclusion Tigecycline could improve the therapeutic effect of complicated intra-abdominal infections, reduce the lactate and procalcitonin levels with high safety.