抗生素经验治疗的选择（英文PPT）Selectionof empiric antibiotic .ppt

April 17, 2010 Fever Increasing FiO2 What Organisms? Stenotrophomonas maltophilia Flavobacterium Pseudomonas aeruginosa April 17, 2010 What antibiotics would you add? Bactrim Doxyclycline Tigecycline Imipenem Chramphenicole * Slide 6 __ __ __ __ __ __ * * * Slide 64. There is variation in the microbial species most often involved in primary, secondary, and tertiary peritonitis. In a majority of patients, primary peritonitis is a result of a monobacterial infection, with E. coli being the most common pathogen.1 Other gram-negative bacteria, such as Klebsiella, are common in peritonitis, as are Streptococcus and Enterococcus species. The microbial etiology of secondary peritonitis depends on the level of gastrointestinal tract disruption.1 Mechanical small-bowel obstruction or an ischemic segment due to any cause results in microbial counts that are much higher than normal.2 Infection with E. coli and B. fragilis, especially in combination, can result in intra-abdominal abscesses and substantial mortality.2 Aerobic and anaerobic bacteria can synergistically enhance virulence; for instance, aerobic bacteria can lower redox potential, thus favoring growth of coexisting anaerobic bacteria.2 Polymicrobial isolates are obtained in more than two thirds of peritonitis and intra-abdominal abscess cases.2 Bacteria commonly involved in secondary peritonitis include the previously discussed B. fragilis and E. coli, as well as Clostridium, Klebsiella, Streptococcus, Enterococcus, and Pseudomonas species. In most clinical settings, 2 to 3 aerobic species and 1 to 2 anaerobic species are identified in patients with secondary peritonitis.2 Involvement of nonendogenous microbes in tertiary infection is debatable, as the definition of tertiary infection is failure of host defenses in the peritoneal cavity rather than invasive infection.2 However, Enterococci, Pseudomonas, S. epidermidis, and Candida may play a role in tertiary infection. References La