外科抗菌药物合理使用.ppt

* Slide Objective: To review the definition of complicated intra-abdominal infection according to the 2003 IDSA Guidelines and orient the audience to the anatomy and pathology associated with peritonitis and abscess formation. Speaker Notes: According to the 2003 IDSA Guidelines: Complicated intra-abdominal infections are defined as infections that extend beyond the hollow viscus of origin into the peritoneal space. In general, infections are considered complicated if they are associated either with abscess formation or peritonitis. By definition, complicated infections require either operative or percutaneous intervention to resolve. References: Solomkin J et al. Clin Infect Dis. 2003 Oct 15;37(8). Mazuski et J al. Surgical Infections. 2002. 3(3):161-173. * Slide Objective: To review types of intra-abdominal infections. Speaker Notes: Intra-abdominal infections encompass a wide variety of markedly different conditions, including: Perforated gastroduodenal ulcers Biliary tract infections Small bowel perforations Complicated appendicitis (with abscess or perforation) Complicated diverticulitis (with abscess or perforation) Reference: Goldstein E. Clin Infect Dis 2002 Sep 1;35(Suppl 1):S106-11. * 外科抗菌药物的合理使用 腹腔感染的内容 狭义上包括腹膜炎、腹腔脓肿和腹膜后感染 腹膜后感染少见 腹膜炎最常见，是最典型的腹腔感染 临床上常把腹膜炎和腹腔感染两个名词混用 广义上还包括腹腔脏器的急性感染性疾病，如阑尾炎、胆囊炎、胰腺炎、肝脓肿 腹腔感染(IAI)的分类 Cheadle W et al. SURGICAL INFECTIONS. 2010;11(5):1-8. 单纯性IAI 常由单一致病菌所致，无解剖屏障的破坏 手术清除感染源，不需抗菌药物 需要手术治疗的腹腔感染性疾病和感染性并发症 术后仍需抗菌治疗残余感染 复杂性IAI 复杂性腹腔感染分类 各种不同病理状态 胃十二指肠溃疡穿孔 胆道感染 小肠穿孔 复杂性阑尾炎(脓肿或穿孔) 复杂性憩室炎(脓肿或穿孔) Goldstein E. Clin Infect Dis 2002 Sep 1;35(Suppl 1):S106-11. Solomkin JS et al. Clin Infect Dis 2003;37:997–1005. Solomkin JS et al. Clin Infect Dis 1992;15(suppl 1):S33–S42. 严重社区获得性复杂腹腔感染死亡率高达30%-50%，造成医疗资源的大量浪费 快速诊断、及时有效的抗感染治疗是获得良好预后的关键 抗菌药物的选择主要取决于病原体的种类，治疗应尽早开展，并持续至临床症状消失后再停止 Cheadle W et al. SURGICAL INFECTIONS. 2010;11(5):1-8. 复杂性腹腔感染常见致病菌 革兰阴性菌 革兰阳性菌 需氧菌 大肠埃希菌 链球菌属 肠球菌属 葡萄球菌 克雷伯菌属 假单