复杂腹腔感染_（一）.pptVIP

For use at meeting only ZYVOX? Speaker Training For use at meeting only. IAI相关指南 the Therapeutic Agents Committee of the Surgical Infection Society,The Surgical Infection Society Guidelines on Antimicrobial Therapy for Intra-Abdominal Infections:An Executive Summary,SURGICAL INFECTIONS Volume 3, Number 3, 2002 IDSA, the Surgical Infection Society, the American Society for Microbiology, and the Society of Infectious Disease Pharmacists,Guidelines for the Selection of Antiinfective Agents for Complicated Intra-abdominal Infections，CID2003, 37:997–1005 Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children:Guidelines by the Surgical Infection Societyand the Infectious Diseases Society of America；Clinical Infectious Diseases 2010; 50:133–64 Infectious Diseases Society of Taiwan; Taiwan Surgical Society of Gastroenterology,etal,Guidelines for antimicrobial therapy of intra-abdominal infections in adults, J Microbiol Immunol Infect. 2008;41:279-281 腹腔感染(IAI)概述 过去一个世纪IAI治疗取得巨大进步，死亡率显著下降 90% in 1900 to 23% in 2002 IAI不同来源感染的死亡率 appendix (0.25%) stomach/duodenum (21%) pancreas (33%) small bowel (38%) large bowel (45%) biliary tract (50%) IAI定义分类 Uncomplicated IAI 单纯性腹腔感染仅累及1个器官,而且没有解剖结构的破坏 通常病灶可完全切除，仅需预防性使用抗菌药物 复杂腹腔感染(cIAI) 复杂腹腔感染(cIAI) 通常定义为空腔脏器的内容穿入腹腔导致局限性腹膜炎(包括脓肿)、弥漫性腹膜炎 感染源经外科处理后，仍残留细菌，需使用抗感染药物 cIAI 更多地与不良预后相关，其最大挑战是早期识别 Primary bacterial peritonitis 指腹腔没有破口的自发性腹膜炎 更多见于婴幼儿、肝硬化及免疫抑制的病人 Secondary bacterial peritonitis 继发性腹膜炎是肠源细菌通过胃肠道穿孔泄漏入腹腔导致的感染炎症 It may be community-acquired or healthcare–associated. Tertiary peritonitis 原发、继发性腹膜炎经治疗后症状仍持续或48小时后症状复苏 常见于有严重合并症或免疫抑制的病人 特点: 医院获得性感染 多为耐药菌 可能为肠道菌群易位 IDSAcIAI指南的定义 该指南排除了肝脾实质的脓疡、泌尿生殖系统来源的感染、后腹膜感染(但除外胰腺感染) 2003版指南不拟适用于小于18岁儿童及原发性腹膜炎，2010版作了扩展 Pathogens associated with peritonitis cIAI综合治疗策略 液体复苏、感染源控制 (ie, surgical debridement, drainage, and repair)、 适当系统地抗感染是cIAI 治疗成功