ABSTRACT
In the period 1990 through 1995, one-hundred patients operated for acute abdomen or admitted on a routine basis, presenting evidence of anaerobic infection, undergo treatment in the clinic of emergency surgery. Septic shock develops in 10/100 patients (10 per cent). In six of the latter the outcome is fatal--three with infection caused by spore-forming anaerobes (gas gangrene of the inguinal region--of Fournier, and anterior abdominal wall--anus praeternaturalis--two), and three with infection caused by non-spore-forming anaerobes (mixed anaerobic-aerobic infection). Anaerobic surgical infection and septic shock specificity is discussed, with an algorithm of therapeutic approach, based on clinical experience had with 100 patients, being proposed in either of them. Special emphasis is laid on antibiotic prophylaxis against anaerobic surgical infection. Its implementation in the concrete clinical conditions in this country demands a clearcut hospital drug policy (adoption of the "Drug Formularies" system), and elaboration of a new economical approach to the choice of antibacterial agents (using some of the forms of pharmaco-economical analysis, practicable with a view to the Bulgarian health-care model).
Subject(s)
Bacteria, Anaerobic , Bacterial Infections/surgery , Shock, Septic/surgery , Abdomen, Acute/drug therapy , Abdomen, Acute/microbiology , Abdomen, Acute/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Anti-Bacterial Agents/therapeutic use , Bacteria, Aerobic , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Combined Modality Therapy , Emergencies , Female , Humans , Male , Middle Aged , Shock, Septic/drug therapy , Shock, Septic/microbiologyABSTRACT
Experience is recorded with lincomycin treatment of 59 patients with acute surgical abdomen. The primary anaerobic flora was eradicated in 86 per cent of the patients. For the very good therapeutic results essential was the early instituted adequate antibiotic therapy in adequate dose and for adequate length of time.