腹腔内感染诊断与治疗.PDFVIP

腹腔內感染診斷與治療 莊捷翰醫師 Chief of surgical department, Kaohsiung Municiple Hsiaokang Hospital, Kaohsiung, Taiwan 2014-11-20 台中榮總內科部會 Classification scheme for IAIs Scandinavian Journal of Surgery 96: 184–196, 2007 The incidence of intra-abdominal infection in Taiwan • Perforated peptic ulcer: 5% • Biliary tract infection: 19% • Small bowel perforation: 2% • Acute appendicitis: 30% • Colon diverticulitis: 15% • Other colon perforation: 9% • Retroperitoneal abscess: 3% • Others: 17% Taiwan National Bureau of Health Insurance 2013 Intra-abdominal Infection ( IAI ) • The result of damaged host defenses • Injury to the epithelial barrier • The pathogens are frequently mixed (aerobes and anaerobes ), often originate from the patient’s own endogenous flora Ann Surg 2006 Intra-abdominal Infection ( IAI ) • The most important aspect is the recognition that operative intervention is required. Ann Surg 2006 Intra-abdominal Infections: General Management Principles • Resuscitation/stabilization of abnormal physiological parameters • Source control: – Important for both complicated and uncomplicated intra- abdominal infections • Antimicrobial therapy Marshall JC: Microbes Infect 2004;6:1015 Improvements in the management of cIAI • Timely and correct diagnosis • Be er surgical technique and post- operative care • Advances in non-operative intervention • Appropriate empirical antimicrobial therapy Chieh-Han C: Form J surg 2009;2:105-113 Diagnosis of IAI 腹痛