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At least 19 recordsLinked to original sources
PubMed1986

Planned reoperation for generalized intraabdominal infection.

Intraabdominal infection remains a common cause of death in surgical patients. Progress in this area with improved survival rates is difficult to demonstrate despite the use of antibiotics, nutritional support, and aggressive maintenance of function of failed organs. This report documents our experience with planned reoperation to cleanse the abdominal cavity in 77 patients with generalized intraabdominal infection. In 34 of the patients, reoperation to cleanse the abdominal cavity was performed every 24 to 48 hours after the first operation until the abdominal cavity was judged to be clean. Forty-three patients underwent a single operation for intraabdominal contamination and were treated expectantly, only undergoing reoperation for signs of recurrent infection. In all patients, the hole in the intestinal tract was controlled primarily by stoma formation at the initial operation to treat intraabdominal infection. Patients with appendiceal disease were excluded. The severity of illness in the two patient groups was compared by a modified acute physiologic score. Planned reoperation was not associated with improvement in survival when compared with patients managed expectantly. Patients managed by planned reoperation had significantly more laparotomies than patients managed expectantly without improving survival. The results of this study disclosed that empiric reoperation to clean the abdominal cavity in patients with generalized intraabdominal infection produced no improvement in survival when compared with observation and reoperation when indicated.

Abdomen↗
PubMed1984

Treatment of intraabdominal infection.

Intraabdominal infections are derived from the flora of the gastrointestinal tract. The upper intestine, from the stomach to the mid-ileum, harbors a sparse microflora. The lower tract harbors a luxuriant flora comprised predominantly of anaerobic bacteria. Bacteriodes fragilis is the leading pathogen in anaerobic infections. In a recent nationwide survey of the susceptibility patterns of B. fragilis the most active beta-lactam antibiotics were cefoxitin, piperacillin and moxalactam. The other active drugs included metronidazole, clindamycin, and chloramphenicol. Many other penicillins and cephalosporins, as well as tetracyclines, showed poor activity. Clinical trials of antimicrobial drugs in intraabdominal infections generally have verified in vitro susceptibility tests. Before accepting a new drug for treating anaerobic infections, it is necessary to establish its efficacy in susceptibility tests, animal models and clinical trials.

Abdomen↗
PubMed1991

Management of intraabdominal infections.

Intraabdominal bacterial infections (secondary peritonitis and intraabdominal abscesses) involve a large number of aerobic and anaerobic organisms and require a multifactorial therapeutic approach that consists of general supportive measures, surgical intervention, and antibiotic treatment. In spite of advances in antibiotic therapy, morbidity and mortality remain high. Well-conducted studies using standardized classification of infections are necessary to determine the best antibiotic regimen, and to lower morbidity and mortality.

Abdomen↗
PubMedDate not supplied

Empiric antibiotic therapy for intraabdominal infections.

Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. The initial escape of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intraabdominal abscesses. These infections are most frequently polymicrobial and relate directly to the unique endogenous microflora at the various levels of the gastrointestinal tract. The treatment of intraabdominal sepsis is primarily centered around prompt, appropriate surgical intervention. parenterally administered antibiotics are also required to decrease the chance of local bacterial invasion or septicemia. The choice of the appropriate agent(s) to be used initially, before culture and sensitivity reports are available, depends primarily on the clinical presentation. Clinical and experimental studies of intraabdominal sepsis have largely stressed the use of antibiotic agents that have a spectrum of activity effective against both the aerobic coliforms and anaerobic Bacteroides fragilis.

Abdomen↗
PubMedDate not supplied

Considerations for therapy of mixed infections: focus on intraabdominal infection.

Intraabdominal infections are a wide range of diseases that include penetrating abdominal trauma, appendicitis, peritonitis, and abscess. Most are polymicrobic, involving aerobic and anaerobic bacteria. The primary treatment is surgery, but important issues regarding administration of antimicrobials may affect patient outcome. Evaluation of an antimicrobial regimen must include consideration of outcomes--survival, organ failure, adverse drug effects, and superinfection. Single-agent regimens have demonstrated benefit in patients with acute intraabdominal contamination and established infections. Guidelines for selecting antimicrobial agents are available from the Surgical Infection Society. Regimens are effective when active against most bacteria isolated from the focus of abdominal infection. The patient's clinical response, not culture results independent of clinical findings, is the primary guide for directing changes in therapy.

Abdomen↗
PubMedDate not supplied

Epidemiology and pathophysiology of intraabdominal infections (IAI).

Intraabdominal infection continues to be one of the major challenges in general surgery. Whilst the term "peritonitis" means an inflammation of the peritoneum regardless of its etiology, intraabdominal infections encompass all forms of bacterial peritonitis, of intraabdominal abscesses and of infections of intraabdominal organs. Several classification systems have been suggested for peritonitis and intraabdominal infections, respectively. However, neither phenomenological classifications nor classification systems with respect to the origin of bacterial contamination have a proven relevance for the clinical course of this disease. Moreover, most of the studies dealing with secondary peritonitis or intraabdominal infections are ill-comparable because of wide variations of inclusion criteria. Thus the true incidence of secondary bacterial peritonitis is difficult to assess. With respect to its etiology perforation of hollow viscus is the leading cause followed by postoperative peritonitis, ischemic damage of bowel wall, infection of intraabdominal organs and translocation in nonbacterial peritonitis. The anatomic origin of bacterial contamination and microbiological findings are no major predictors of outcome. However, the preoperative physiological derangement, the surgical clearance of the infectious focus and the response to treatment are established prognostic factors. The pathogenesis of intraabdominal infections is determined by bacterial factors which influence the transition from contamination to infection. Intraabdominal adjuvants and the local host response are additionally important. Bacterial stimuli lead to an almost uniform activation response which is triggered by reaction of mesothelial cells and interspersed peritoneal macrophages and which also involves plasmatic systems, endothelial cells and extra- and intravascular leukocytes. The local consequences of this activation are the transmigration of granulocytes from peritoneal capillaries to the mesothelial surface and a dilatation of peritoneal blood vessels resulting in enhanced permeability, peritoneal edema and lastly the formation of protein-rich peritoneal exudate.

Abdomen↗
PubMedDate not supplied

A randomized controlled trial of ampicillin plus sulbactam vs. gentamicin plus clindamycin in the treatment of intraabdominal infections: a preliminary report. Study Group of Intraabdominal Infections.

This is a preliminary report of a comparative study of sulbactam plus ampicillin (sulbactam/ampicillin) vs. gentamicin plus clindamycin (gentamicin/clindamycin) in surgically treated patients with intraabdominal infections. Among 46 assessable patients in the sulbactam/ampicillin group, 40 were clinically cured or improved as compared with 36 of 37 patients in the gentamicin/clindamycin group. Among 40 microbiologically assessable patients in the sulbactam/ampicillin group, the pathogen was eradicated in 33 patients and partially eradicated in two, whereas eradication was recorded in 21 and partial eradication in 10 of the 32 patients in the gentamicin/clindamycin group. Among 150 aerobic isolates, 14 were resistant to sulbactam/ampicillin, 27 were resistant to gentamicin/clindamycin, and 85 were beta-lactamase producers. No resistance to sulbactam/ampicillin was found in 75 anaerobic isolates, whereas one anaerobic isolate was resistant to clindamycin. This preliminary report suggests that ampicillin/sulbactam is a useful nontoxic alterative to gentamicin/clindamycin in the treatment of intraabdominal infections.

Abdomen↗
PubMed1993

Wound and intraabdominal infections: microbiological considerations and approaches to treatment.

Aerobic and anaerobic bacteria normally found in the human endogenous gastrointestinal microflora are the most frequent isolates from both postoperative incisional infections and intraabdominal infections. Experimental and clinical studies of intraabdominal infections have shown that many factors are important for successful treatment. Most important is rapid diagnosis followed by a carefully chosen and performed operation. The initial choice of antibiotics with both aerobic and anaerobic coverage has been associated with a high level of therapeutic success in both clinical and experimental settings. In addition, patients with severe intraabdominal infections appear to benefit from a scheduled postoperative relaparotomy with irrigation and exploration, which is most often done today with a zipper technique and which reduces the bacterial burden within the peritoneal cavity. The use of this approach may facilitate the action of properly chosen and administered parenteral antibiotics.

Abdomen↗
PubMed2000

Bacteriological study of 28 patients with intraabdominal infection in Japan.

Intraabdominal infections are usually polymicrobial, including both aerobes and anaerobes. To assess the importance of anaerobes in intraabdominal infection, a bacteriological study was performed. The subjects studied were 28 inpatients with acute abdomen who visited Gifu Red Cross Hospital, Gifu, Japan, between May 1996 and July 1998. Twenty-one patients had abscess or peritonitis caused by perforation of the gastrointestinal tract, 4 had liver abscess, 2 had pelvic abscess, and 1 had retroperitoneal and subcutaneous abscess. Most specimens were cultured within 6 h after sampling. Using the E test, we tested the susceptibilities of isolates to 11 antimicrobial agents. Anaerobes were predominantly recovered from intraabdominal infection caused by perforation of the small bowel, appendix, and large bowel. The anaerobes isolated were resistant to the cephems tested, to which the aerobic strains were susceptible. It is suggested that carbapenems may be the choice for treatment of severe intraabdominal infection, especially that resulting from perforation of the small bowel, appendix, and large bowel.

Abdominal Abscess↗
PubMed1992

Evaluation of new anti-infective drugs for the treatment of intraabdominal infections. Infectious Diseases Society of America and the Food and Drug Administration.

These guidelines deal with the evaluation of anti-infective drugs for the treatment of intraabdominal infections. The clinical entities consist of infections arising from any part of the gastrointestinal tract, from the distal esophagus to the colon. These include surgical infections of the bowel, biliary tree, liver, spleen, and pancreas. Virtually all intraabdominal infections are due to multiple microorganisms resident in the gastrointestinal tract; these include aerobes and facultative and obligate anaerobes. Infections are classified as complicated (requiring an operative procedure), uncomplicated (managed medically), and postoperative wound (the operative procedure should be curative, but anti-infective drugs are used to prevent further infection at the site). Clinical criteria are paramount for entry into a study and for evaluation of efficacy. For complicated infections an adequate operation is an important determinant of outcome and needs assessment. Cultures of purulent intraabdominal fluid or abscess material are the only valid microbiologic indicators of infection. The acute physiology and chronic health evaluation score is useful in defining the severity of acute illness. The control regimen should consist of effective, established drugs and surgical procedures for the condition. Duration of therapy for complicated infections is usually 5-14 days; for uncomplicated infections, 3-7 days; and for postoperative wound infection, 2-5 days. Periodic assessment of safety and efficacy must be conducted during therapy. The outcome at final assessment is cure, failure, or indeterminate.

Anti-Infective Agents↗
PubMedDate not supplied

Intraabdominal infections: an overview.

Intraabdominal infections are serious clinical problems that generally occur secondary to endogenous contamination following the interruption of the continuity of the gastrointestinal tract by trauma, intrinsic diseases, or surgery. Appropriate treatment necessitates early diagnosis, the accomplishment of which most frequently requires a specialized radiologic procedure such as computed tomography, followed by surgical drainage and appropriate parenteral antibiotic therapy. Several agents alone or others in combination appear to be equally efficacious in treating these infections, which usually are due to the aerobic and anaerobic constituents of the gastrointestinal microflora. Adjunctive surgical techniques include peritoneal irrigation, debridement, and repair of the damaged viscera.

Abdomen↗
PubMed1995

Biapenem versus imipenem in the treatment of experimental intraabdominal infections.

A reproducible experimental model of intraabdominal infections in rats has been devised in order to simulate intraabdominal infections in patients. The experimental model was used to compare the efficacy of biapenem with imipenem. Three groups of animals were used, each group consisting of 20 animals. Antibacterial agents were given by injection initially 1 h after surgery and then at 12 h intervals for 12 days. The drugs and amounts of agents given per dose were biapenem 10 mg and imipenem 10 mg, respectively. The control group received 0.9% sterile saline. 80% of the untreated animals died within 3 days. Animals treated with biapenem or imipenem had a significantly decreased mortality and increased cure rates during the experimental period. Only two animals in the two treatment groups died. Biapenem seems to be useful in the treatment of intraabdominal infections.

Abdomen↗
PubMed2002

Outcome analysis of intraabdominal infection with resistant gram-positive organisms.

BACKGROUND: Although the microbiology of intraabdominal infection has been well described, the role of resistant organisms remains unclear. To evaluate the hypothesis that intraabdominal infections from resistant gram-positive cocci (rGPC) have worse outcomes compared to those with susceptible organisms, patient characteristics and outcomes were compared between these groups. METHODS: Analysis of peritoneal infections was performed on prospectively collected data of all consecutive surgical infections from December 1996 to June 1999 at a university hospital. Intraabdominal infection was defined either by a positive peritoneal cavity culture or on clinical grounds (e.g., abscess), which prompted antimicrobial or surgical therapy. Resistant Staphylococcus and Enterococcus spp. were defined as those strains resistant to oxacillin, gentamicin, or vancomycin. RESULTS: Compared to episodes of intraabdominal infection from susceptible organisms (n = 365), infections due to rGPC (n = 52) were associated with an increased severity of illness (p < 0.0001), longer time from admission to treatment (p < 0.0001), longer duration of therapy (p = 0.008), greater proportion of nosocomial infection (p < 0.0001), increased length of stay (p < 0.0001), and an increased mortality rate (9% versus 23%; p = 0.003). However, comparison of intraabdominal infection with rGPC to a group controlled for severity of illness demonstrated a prolonged time from admission until treatment and longer duration of hospitalization but a similar mortality rate between groups (17% versus 23%; p = 0.46). CONCLUSION: Intraabdominal infection with rGPC is an indicator of poor prognosis and severe illness. Although not an independent predictor of mortality, the significantly increased duration of therapy and prolonged duration of hospitalization may have considerable economic impact.

Abdomen↗
PubMed1988

Newer cephalosporins: lessons to be learned from clinical trials in intraabdominal infections.

Recent clinical trials testing the efficacy of newer cephalosporins in intraabdominal infections lack a number of the study design criteria proposed by Solomkin et al. Nevertheless, these trials all support the use of these newer cephalosporins in the treatment of intraabdominal infections. These newer agents demonstrate increased in vitro antimicrobial activity against potential aerobic pathogens, which suggests that they may be used in combination with an antianaerobic drug in the treatment of intraabdominal infections. Therefore, agents including cefotaxime, cefoperazone, ceftazidime, cefuroxime, ceftriaxone, and aztreonam may be chosen in place of the standard aminoglycoside. Previous studies have demonstrated the necessity of both aerobic and anaerobic coverage in empiric therapy of intraabdominal infections. Cefotetan, ceftizoxime, cefoxitin, moxalactam, mezlocillin, and piperacillin all have in vitro activity against aerobes and anaerobes (including B. fragilis), thus, these agents have a potential as monotherapy for acute intraabdominal infections in otherwise healthy patients. Directed combination chemotherapy or perhaps imipenem alone is recommended for persistent peritonitis and intraabdominal infections in immunocompromised hosts.

Abscess↗
PubMedDate not supplied

Single-agent versus combination antibiotic therapy in the management of intraabdominal infections.

For the treatment of intraabdominal infection, single-agent antimicrobial regimens such as beta-lactams with good antianaerobic activity are frequent alternatives to combination regimens such as aminoglycosides or aztreonam plus an antianaerobic agent such as clindamycin or metronidazole. The major issues in selecting a regimen are relative efficacy, potential for adverse drug effects, and cost. Single agents are clearly equivalent to combinations in preventing infectious complications after penetrating abdominal trauma and in treating established intraabdominal infections of mild to moderate severity or in relatively low-risk patients. A few trials demonstrated their equivalency in patients at high risk of mortality, although experience is limited. Single-agent regimens may reduce the risks of adverse drug effects compared with combination regimens, but they are not always less expensive.

Abdomen↗
PubMedDate not supplied

The treatment of intraabdominal infections in surgery.

Intraabdominal sepsis is frequently seen following penetrating or blunt abdominal trauma as well as with perforated appendicitis or diverticulitis. The initial leakage of endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which often results in a localized intraabdominal abscess. These infections are commonly polymicrobial and correlate directly with the unique endogenous microflora at various levels of the gastrointestinal tract. The successful treatment of intraabdominal sepsis is primarily associated with prompt, appropriate surgical intervention. Parenterally administered antibiotics are also required to decrease the incidence of local bacterial infection or septicemia. The choice of the appropriate agent(s) to be used initially, before obtaining the results of culture and sensitivity tests, depends primarily on both the clinical presentation and on whether the intraabdominal infection occurred in the community or as a result of hospitalization. Clinical and experimental studies of intraabdominal sepsis have primarily emphasized the use of antibiotic agents that have a spectrum of activity effective against aerobic coliforms and the anaerobe Bacteroides fragilis.

Abdomen↗
PubMed1998

[Prospective randomized trial of meropenem versus cefotaxime and metronidazole in the treatment of intraabdominal infections].

BACKGROUND: The empiric antibiotic treatment of intraabdominal infections is in constant evolution. Monotherapy appears to be a desirable goal because of the simplicity of its administration, lack of toxic effects and wide spectrum. PATIENTS AND METHODS: A multicentre, prospective, randomized, open study was carried out to compare two antibiotic regimens in the treatment of intraabdominal infections in patients undergoing surgery. Ninety-eight consecutive patients were randomly allocated into two groups. One group (GM, n = 51) received meropenem (1 g/8 h) and the other (GCM, n = 47) a combination of cefotaxime (2 g/8 h) plus metronidazol (0.5 g/8 h). Clinical and bacteriological responses were assessed at the end of treatment and at 2-4 weeks. RESULTS: The severity of patients as assessed by the APACHE II score was similar in both groups (GM: 7.2 and GCM: 8.1). Three patients in each group could not be evaluated due to premature interruption of treatment or deviation from the protocol. The mean duration of treatment was 7.4 days in GM and 7.9 days in GCM. A satisfactory clinical response was obtained in 95% of patients in both groups. 31 patients (61%) in GM and 26 patients (55%) in GCM were bacteriologically evaluable. Bacteriological erradication was achieved in 94% of patients in GM and in 92% of patients in GCM. CONCLUSION: Meropenem is a good alternative for single antibiotic therapy in intraabdominal infections of moderate severity.

Abdomen↗
PubMed2000

Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection.

Some patients are prone to persisting intraabdominal infection regardless of initial eradication of the source of infection. Our aim was to characterize patients who had to undergo relaparotomy for persisting abdominal sepsis using simple clinical parameters and to define those patients who are susceptible to benefit of aggressive surgical treatment by early and repeated reoperations to control multiple organ dysfunction syndrome (MODS) caused by ongoing intraabdominal infection. Persisting abdominal sepsis was the cause of death in all of our patients who had to undergo relaparotomy. Controlling persisting abdominal sepsis should achieve a reduction in the tremendously high mortality rate. Performing a case-control study, we retrospectively reviewed 523 consecutive patients with secondary peritonitis treated from 1986 to 1996 and focused our attention on 105 patients, in whom standard surgical treatment of secondary peritonitis failed and who had to undergo relaparotomy for persisting abdominal sepsis (study group). Overall, there was no significant difference in the postoperative mortality rate between "planned relaparotomy" and "relaparotomy on demand" (54.5% versus 50. 6%). Equally clear risk estimations were given preoperatively by both the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Goris scores. There was a significant difference between patients of the control group and patients of the study group with regard to preoperative APACHE II score, Goris score, age >70 years, albumin <30 g/L, extent of peritonitis, and outcome (p = 0.0001). Reexploration performed more than 48 hr after the initial operation resulted in a significantly higher mortality rate (76.5% versus 28%; p = 0.0001). However, the time of reoperation had no significant impact on survival in patients with an APACHE II score of > or = 26, because physiologic derangement is such that only a few patients could benefit from reoperation. The lowest mortality rate (9%) was achieved in patients who underwent reoperation on demand within 48 hr. We conclude that patients >70 years of age with secondary peritonitis extending over the entire abdomen and a greater degree of physiologic compromise (serum albumin levels <30 g/L, preoperative APACHE II scores >20, and existing organ failure measured by the Goris score) are at high risk for developing persistent intraabdominal infection. Our data show that timely relaparotomy provides the only surgical option that significantly improves outcome. However, aggressive surgical treatment has reached its limit in patients whose source of infection could not be controlled at the initial operation. To improve overall survival the decision to perform a relaparotomy on demand after an initially successful eradication of the source of infection must be made within 48 hr, at least before MODS emerges.

Abdomen↗