Intra-abdominal infections

Microbial structure of intra-abdominal infections

These microbiological studies are crucial for the rational therapy of abdominal infections in surgery. Microbiological diagnosis can identify resistant bacteria and in a timely manner to optimize the use of antibiotics. Studies conducted in our clinic and at other centers confirm the polymicrobial nature of intra-abdominal infections involving a wide spectrum of aerobic and anaerobic Gram-negative and gram-positive bacteria [3, 6].

The main causative agents of infectious diseases and complications in surgical patients are Gram-negative bacteria, the primary among which are representatives of Enterobacteriaceae (E. coli, Proteus spp., Klebsiella-Enterobacter-Serratia), Pseudomonas, as well as asporogenous anaerobes, especially bacteroides. In the overall structure of intra-abdominal infections Gram-positive organisms account for one third [3, 6]. When intra-abdominal abscesses of different localization established dominance of anaerobic bacteria (bacteroides, fuzobakterii, peptokokk, clostridia) in association with aerobes.

It should be noted that in the microbiological structure of intra-abdominal brand viagra infectious complications developing in the postoperative period or during the hospital stay, special significance of hospital strains of pathogens: coagulase-negative staphylococci, enterococci, Enterobacteriaceae, and Pseudomonas atsinetobakter. These organisms are highly polyvalent and antibiotic resistance, which is extremely difficult to effective treatment of patients. Huge problem in this respect are gram-negative microorganisms, such as, Acinetobacter spp., Resistant to many antibiotics. Effective against these pathogens only carbapenems, some cephalosporins and aminoglycosides (netilmicin, amikacin).

The results of microbiological studies are the foundation of the regime targeted antibiotic therapy. Correctness and reliability of these expensive studies depends on the compliance sampling of biological material.

Causes of false negative and false-positive results of microbiological studies are errors with the fence material and transporting it to the lab; bactericidal activity of antiseptics, local anesthetics and drugs acting on the CNS, which are used in anesthesia and surgical procedures, lack of precision in assessing antibiotic susceptibility in vitro. However, it should be emphasized that microbiological investigations are the basis for evidence-based clinical trials evaluating the effectiveness of antimicrobial agents.

Principles of antibiotic therapy for intra-abdominal infections

The problem of antimicrobial therapy in complex treatment of patients with complicated intra-abdominal surgical infections blockade of systemic inflammatory response at the level of exogenous microbial mediators. In a clinical sense, it is primarily to prevent persistence of generalization and relapse of infection in the vast surface of the peritoneum, or retroperitoneal space. Major role in the treatment of complications of intra-abdominal infections is adequate surgical intervention. However, the contribution of antibiotic therapy in reducing mortality in patients with peritonitis from 1900 to 1980 did not exceed 20% [10]. In fairness it should be noted that the importance of intensive therapy in improving outcomes of abdominal sepsis is around 15%. The remaining 70% are a function of optimizing the surgical treatment and diagnosis. However, inadequate antimicrobial therapy plays a very significant negative role.

Basic principles of antibacterial therapy (ABT) in abdominal surgery include the following:

ABT, as a mandatory component of complex therapy intra-abdominal infections, surgical treatment is only complements, but does not replace it.

TSA aims to prevent the continuing re-infection after the operation at the source of infection and, thus, the prevention of recurrent intra-abdominal infections.

ABT is the main treatment ekstraabdominalnyh nosocomial infections (pneumonia, tracheobronchitis, uroinfektsiya), provided the cause of its development.

TSA, in contrast to other types of drug therapy has a significant focus of specific action against the major causative agents of surgical infection. In connection with this action of the antibiotic depends on its ability to penetrate the infected tissues and organs, ie, an optimal concentration of the inflammation, as determined by the pharmacodynamic characteristics of the antibiotic.

ABT surgical infection should take into account the potential adverse and toxic effects of the drug, the severity of the main and concomitant diseases.

ABT can not be ignored, and economic issues. Crucial for the results of complex treatment of patients with abdominal sepsis is adequate empirical therapy, ie, therapy prior to viagra help with premature ejaculation microbiological data in individual patients.

Strategy ABT intra-abdominal infections should be a two-step.

The first stage of most early treatment most effective antibiotic or a combination thereof. Selection is determined by the severity of the patient, the localization of infection and suspected pathogens. Where indicated the serious condition of the patient, nosocomial infections, etc. appropriate use of drugs such as carbapenems, cephalosporins IV generation inhibitor penicillins (IZP), fluoroquinolones.

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