胃肠道手术后腹腔感染诊治策略

Strategy of diagnosis and management of intra-abdominal infection after gastrointestinal surgery

腹腔感染是胃肠手术后常见并发症,常与病人病情危重、疾病控制不良、抗生素治疗不当或发生医疗相关感染有关,是导致病人死亡的主要原因。腹腔感染的早期评估有助于筛选高危病人,以便采用更积极治疗方案。复杂腹腔感染治疗的关键在于控制病源和合理使用抗生素。而病源控制的时间和力度又是控制腹腔感染的重点。目前抗生素的经验性治疗在腹腔感染的治疗中仍占有非常重要的地位。不适当的抗生素治疗可致病人预后不良,增加细菌耐药性。多重耐药菌感染、使用免疫抑制或长期抗生素治疗病人,推荐首选强力抗菌药物。

Intra-abdominal infection after gastrointestinal operation has become an important cause of morbidity and are frequently associated with poor prognosis. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The key point in the management of complicated intra-abdominal infections is both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections. Empiric antimicrobial therapy is important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. A deescalation approach may be recommended in patients with specific risk factors for muhidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure.