Analysis of surgical treatment and outcomes of complicated intraabdominal infections

Year 2018, Volume: 4 Issue: 2, 791 - 807, 15.08.2018

Sabri Özdaş Safa Önel Mehmet Şirik

https://doi.org/10.30569/adiyamansaglik.415553

Abstract

Aim: Despite recent advances in treatment, the mortality rate due to
complicated intra-abdominal infection (cIAI) still remains high We aimed to
present the clinical characteristics and outcome of patients with cIAI who were
treated surgically.

Methods: Seventy-two patients (28 female, 44 male; mean age 44.2 years) who were
diagnosed with cIAI and underwent surgical treatment between May 2012 and May
2013 included in this study. The clinical characteristics of patients, origin
of infection, microbiology of peritoneal fluid, and outcome of surgery were
also recorded.

Results: Sixty-one patients (84.7%) acquired cIAI from community, whereas 11
patients (15.3%) from nosocomial sources. Twenty-four patients (33.3%) had
disseminated peritonitis, and the remaining 48 patients (66.6%) had local
peritoneal infection or abscesses. Infected fluid from peritoneal cavity was positive
for E. coli in 27 patients (38%), and
for B. fragilis in 17 patients (24%).
Fourteen patients (19.4%) were followed up in the intensive care unit. Overall
postoperative mortality rate was 8.3% (6 patients).

Conclusion: The cIAI is an emergency
medical condition with high mortality rate. In addition to early diagnosis and
preventive measures, advanced surgical techniques and postoperative care are
critical to obtain better outcomes.

Keywords

Complicated intra-abdominal infection, Peritonitis, Antibiotic therapy

Komplike İntraabdominal Enfeksiyonların Cerrahi Tedavi ve Sonuçlarının Analizi

Abstract

Amaç: Bu çalışmamızda kliniğimize akut karın bulguları ile gelen ve opere edilen komplike karın içi enfeksiyonlu hastaların pre-postop
takip ve tedavilerinin mortalite ve morbiditelerini izlemsel olarak ortaya
koyulmasını amaçladık.

Yöntemler: Çalışmamız kliniğimizde Mayıs 2012 ile Mayıs 2013 tarihleri arasında
opere komplike karın içi enfeksiyonlu hastaların verilerini içermektedir. Bu
veriler şunlardır: (i) hasta ve hastalık özellikleri, yani, demografik veriler,
enfeksiyon tipi, şiddet kriteri, ameliyat öncesinde 7 gün uygulanan küratif
antibiyotik tedavisi; (ii) enfeksiyon kökeni ve uygulanan cerrahi işlemler
(iii) mikrobiyolojik veriler ve bakteriyel izolatların antibiyotik
duyarlılıklarıdır. Hastaların hastanede toplam kalış süreleri, post-op yoğun
bakımda takip edilen hasta sayısı dikkate ve bu verilerin istatiksel analizleri
anlatılmıştır.

Bulgular: Çalışmaya 28( % 38,8)’i kadın, 44( % 61,2 )’ü erkek olmak üzere 72
hasta dahil edildi. Hastaların radyolojik olarak ADBG, USG ve karın CT ile
teyit edilmiş, klinik tam parametreleri ortaya konulmuş ve gelen hastaların %
100’de Karın ağrısı ve karında hassasiyet ön planda olmuştur. Aynı zamanda risk
faktörleri skalası ortaya konulmuştur. 24(% 33,3) hastada yaygın periton
enfeksiyonu gözlemlenirken 48(% 66,6) hastada lokal periton enfeksiyonu yada
apseler bildirilmiştir. 72(% 100) hastadan kültür amaçlı batın içi enfekte sıvı
alındı. 14 hasta (% 19,4) durumu kritik olarak kabul edildi ve yoğun bakım
ünitesinde takip edildi. Hastaların 66(% 91,6) ilk geliş beyaz küreleri
yüksekti, 4(% 5,5) hastada aldıkları kemoterapi nedeniyle beyaz küre’leri
normalin altındaydı.

Sonuç: Komplike İntraabdominal Enfeksiyonlar mortalite oranının yüksek olduğu
acil bir tıbbi durumdur. Erken tanı ve önleyici tedbirlerin yanı sıra, ileri
cerrahi teknikler ve postoperatif bakım daha iyi sonuçların elde edilmesi için
kritik öneme sahiptir.

Keywords

Komplike karın içi enfeksiyon, Peritonit, Antibiyotik tedavisi

References

• 1. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg 2010; 5: 9.
• 2. Friedrich AK, Cahan M. Intraabdominal infections in the intensive care unit. J Intensive Care Med 2014; 29: 247-254.
• 3. Herzog T, Chromik AM, Uhl W. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Eur J Med Res 2010; 15: 525-532.
• 4. Sartelli M, Viale P, Koike K, Pea F, Tumietto F, van Goor H, Guercioni G, Nespoli A, Tranà C, Catena F, et al. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections. World J Emerg Surg 2011; 6: 2.
• 5. Skrupky LP, Tellor BR, Mazuski JE. Current strategies for the treatment of complicated intraabdominal infections. Expert Opin Pharmacother 2013; 14: 1933-1947.
• 6. Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, Malangoni M, Velmahos G, Coimbra R, Koike K, et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World Journal of Emergency Surgery : WJES 2014; 9: 37.
• 7. Ouyang W, Xue H, Chen Y, Gao W, Li X, Wei J, Wen Z. Clinical characteristics and antimicrobial patterns in complicated intra-abdominal infections: a 6-year epidemiological study in southern China. Int J Antimicrob Agents 2016; 47: 210-216.
• 8. van Ruler O, Boermeester MA. Surgical treatment of secondary peritonitis: A continuing problem. Chirurg 2016; 87: 13-19.
• 9. Esteban A, Frutos-Vivar F, Ferguson ND, Peñuelas O, Lorente JA, Gordo F, Honrubia T, Algora A, Bustos A, García G, Diaz-Regañón IR, de Luna RR. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 2007; 35: 1284-1289.
• 10. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy collaborative group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Eng J Med 2001; 345: 1368-1377.
• 11. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 2010; 11: 79-109.
• 12. Spirt MJ. Complicated intra-abdominal infections: a focus on appendicitis and diverticulitis. Postgrad Med 2010; 122: 39-51. 13. Sartelli M, Catena F, Ansaloni L, Leppaniemi A, Taviloglu K, van Goor H, Viale P, Lazzareschi DV, Coccolini F, Corbella D, et al. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study. World J Emerg Surg 2012; 7: 36.
• 14. Brozek JL, Akl EA, Jaeschke R, Lang DM, Bossuyt P, Glasziou P, Helfand M, Ueffing E, Alonso-Coello P, Meerpohl J, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies. Allergy 2009; 64: 1109-1116.
• 15. Inui T, Haridas M, Claridge JA, Malangoni MA. Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection. Surgery 2009; 146: 654-661.
• 16. Menichetti F, Sganga G. Definition and classification of intra-abdominal infections. J Chemother 2009; 21: 3-4.
• 17. Jean SS, Ko WC, Xie Y, Pawar V, Zhang D, Prajapati G, Mendoza M, Kiratisin P, Ramalheira E, Castro AP, et al. Clinical characteristics of patients with community-acquired complicated intra-abdominal infections: a prospective, multicentre, observational study. Int J Antimicrob Agents 2014; 44: 222-228.
• 18. Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg 2007; 96:184-196.
• 19. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 2010; 147:818-829.
• 20. Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011; 150: 673-683.
• 21. Mason RJ, Moazzez A, Sohn H, Katkhouda N. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect (Larchmt) 2012; 13: 74-84.
• 22. Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 2012, 344: e2156.
• 23. Millat B, Fingerhut A, Borie F. Surgical treatment of complicated duodenal ulcers: controlled trials. World J Surg 2000; 24: 299-306. 24. Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg 1998; 133: 173-175.
• 25. Hadad SM, Vaidya JS, Baker L, Koh HC, Heron TP, Hussain K, Thompson AM. Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis. World J Surg 2007; 31: 1298-1301.
• 26. Kriwanek S, Armbruster C, Dittrich K, Beckerhinn P. Perforated colorectal cancer. Dis Colon Rectum 1996; 39: 1409-1414.
• 27. Won DY, Lee IK, Lee YS, Cheung DY, Choi SB, Jung H, Oh ST. The indications for nonsurgical management in patients with colorectal perforation after colonoscopy. Am Surg 2012; 78: 550-554.
• 28. Meyer F, Marusch F, Koch A, Meyer L, Führer S, Köckerling F, Lippert H, Gastinger I. German study group "colorectal carcinoma (primary tumor)". Emergency operation in carcinomas of the left colon: value of Hartmann's procedure. Tech Coloproctol 2004; 8: 226-229.
• 29. Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K, AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 2012; 99: 532-539.
• 30. Augustin P, Kermarrec N, Muller-Serieys C, Lasocki S, Chosidow D, Marmuse JP, Valin N, Desmonts JM, Montravers P. Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis. Crit Care 2010; 14: R20.
• 31. Benoist S, Panis Y, Pannegeon V, Soyer P, Watrin T, Boudiaf M, Valleur P. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg 2002; 184: 148-153.
• 32. Theisen J, Bartels H, Weiss W, Berger H, Stein HJ, Siewert JR. Current concepts of percutaneous abscess drainage in postoperative retention. J Gastrointest Surg 2005; 9: 280-283.
• 33. Hasper D, Schefold JC, Baumgart DC. Management of severe abdominal infections. Recent Pat Antiinfect Drug Discov 2009; 4: 57-65.
• 34. Kurup A, Liau KH, Ren J, Lu MC, Navarro NS, Farooka MW, Usman N, Destura RV, Sirichindakul B, Tantawichien T, et al. Antibiotic management of complicated intra-abdominal infections in adults: The Asian perspective. Ann Med Surg (Lond) 2014; 3: 85-91.
• 35. Solomkin JS, Mazuski JE, Baron EJ, Sawyer RG, Nathens AB, DiPiro JT, Buchman T, Dellinger EP, Jernigan J, Gorbach S, et al. Infectious Diseases Society of America. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis 2003; 37: 997-1005.
• 36. Blot S, De Waele JJ, Vogelaers D. Essentials for selecting antimicrobial therapy for intra-abdominal infections. Drugs 2012; 72:17-32.
• 37. Eckmann C, Dryden M, Montravers P, Kozlov R, Sganga G. Antimicrobial treatment of "complicated" intra-abdominal infections and the new IDSA guidelines? A commentary and an alternative European approach according to clinical definitions. Eur J Med Res 2011; 16: 115-126.