Intra-abdominal sepsis in the critically ill

2016 ◽  
Author(s):  
Jeffrey D. Doyle ◽  
John C. Marshall
Keyword(s):  
Critically Ill ◽  
Anaerobic Bacteria ◽  
Abdominal Sepsis ◽  
Source Control ◽  
Successful Management ◽  
Abdominal Infection ◽  
Infectious Disease Specialists ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Prompt Diagnosis

Intra-abdominal infection encompasses a broad group of infections arising both within the peritoneal cavity and the retroperitoneum. The probable bacteriology reflects patterns of normal and pathological colonization of the gastrointestinal tract. Anaerobic bacteria are found in the distal small bowel and colon. The abdomen is the second most common site of infection leading to sepsis in critically-ill patients. Intra-abdominal infections can be complex to manage and require excellent collaboration between intensivists, diagnostic and interventional radiologists, surgeons, and sometimes gastroenterologists and infectious disease specialists. Prompt diagnosis, appropriate antimicrobial coverage and timely source control are the cornerstones of successful management. The spectrum of pathologic conditions responsible for intra-abdominal infection is broad, although some common biological features facilitate an understanding of their diagnosis and management.

Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection

2019 ◽  
Vol 52 ◽  
pp. 258-264 ◽  
Author(s):  
Kirsten van de Groep ◽  
Tessa L. Verhoeff ◽  
Diana M. Verboom ◽  
Lieuwe D. Bos ◽  
Marcus J. Schultz ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Source Control ◽  
Abdominal Infection ◽  
Control Procedures ◽  
Intra Abdominal Infection

scholarly journals Successful management of emphysematous gastritis with invasive gastric mucormycosis

2020 ◽  
Vol 13 (2) ◽  
pp. e231297 ◽  
Author(s):  
Digvijoy Sharma
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Favourable Outcome ◽  
Source Control ◽  
Successful Management ◽  
Emphysematous Gastritis ◽  
Prompt Diagnosis ◽  
Early Surgical Intervention

The present manuscript reports two extremely rare cases of coexisting emphysematous gastritis with gastric mucormycosis. The cases were managed successfully, considering the high mortality associated with both conditions independently. The aim of the manuscript is to elucidate the importance of prompt diagnosis, early surgical intervention for source control and concomitant application of antifungal therapy for a favourable outcome.

scholarly journals Comparative Population Plasma and Tissue Pharmacokinetics of Micafungin in Critically Ill Patients with Severe Burn Injuries and Patients with Complicated Intra-Abdominal Infection

2016 ◽  
Vol 60 (10) ◽  
pp. 5914-5921 ◽  
Author(s):  
A. García-de-Lorenzo ◽  
S. Luque ◽  
S. Grau ◽  
A. Agrifoglio ◽  
L. Cachafeiro ◽  
...  
Keyword(s):  
Critically Ill ◽  
Body Surface ◽  
Candida Parapsilosis ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Content Type ◽  
Abdominal Infection ◽  
Area Burned ◽  
Total Body ◽  
Intra Abdominal Infection

ABSTRACTSeverely burned patients have altered drug pharmacokinetics (PKs), but it is unclear how different they are from those in other critically ill patient groups. The aim of the present study was to compare the population pharmacokinetics of micafungin in the plasma and burn eschar of severely burned patients with those of micafungin in the plasma and peritoneal fluid of postsurgical critically ill patients with intra-abdominal infection. Fifteen burn patients were compared with 10 patients with intra-abdominal infection; all patients were treated with 100 to 150 mg/day of micafungin. Micafungin concentrations in serial blood, peritoneal fluid, and burn tissue samples were determined and were subjected to a population pharmacokinetic analysis. The probability of target attainment was calculated using area under the concentration-time curve from 0 to 24 h/MIC cutoffs of 285 forCandida parapsilosisand 3,000 for non-parapsilosis Candidaspp. by Monte Carlo simulations. Twenty-five patients (18 males; median age, 50 years; age range, 38 to 67 years; median total body surface area burned, 50%; range of total body surface area burned, 35 to 65%) were included. A three-compartment model described the data, and only the rate constant for the drug distribution from the tissue fluid to the central compartment was statistically significantly different between the burn and intra-abdominal infection patients (0.47 ± 0.47 versus 0.15 ± 0.06 h−1, respectively;P< 0.05). Most patients would achieve plasma PK/pharmacodynamic (PD) targets of 90% for non-parapsilosis Candidaspp. andC. parapsilosiswith MICs of 0.008 and 0.064 mg/liter, respectively, for doses of 100 mg daily and 150 mg daily. The PKs of micafungin were not significantly different between burn patients and intra-abdominal infection patients. After the first dose, micafungin at 100 mg/day achieved the PK/PD targets in plasma for MIC values of ≤0.008 mg/liter and ≤0.064 mg/liter for non-parapsilosis Candidaspp. andCandida parapsilosisspecies, respectively.

scholarly journals Antibiotic susceptibility of intra-abdominal infection isolates from Indian hospitals during 2008

2010 ◽  
Vol 59 (9) ◽  
pp. 1050-1054 ◽  
Author(s):  
Stephen P. Hawser ◽  
Robert E. Badal ◽  
Samuel K. Bouchillon ◽  
Daryl J. Hoban ◽  
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Antimicrobial Resistance ◽  
Gram Negative ◽  
E Coli ◽  
Abdominal Infection ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Very High

A total of 542 clinical isolates of aerobic Gram-negative bacilli from intra-abdominal infections were collected during 2008 from seven hospitals in India participating in the Study for Monitoring Antimicrobial Resistance Trends (SMART). Isolates were from various infection sources, the most common being gall bladder (30.1 %) and peritoneal fluid (31.5 %), and were mostly hospital-associated isolates (70.8 %) as compared to community-acquired (26.9 %). The most frequently isolated pathogens were Escherichia coli (62.7 %), Klebsiella pneumoniae (16.7 %) and Pseudomonas aeruginosa (5.3 %). Extended-spectrum β-lactamase (ESBL) rates in E. coli and K. pneumoniae were very high, at 67 % and 55 %, respectively. Most isolates exhibited resistance to one or more antibiotics. The most active drugs were generally ertapenem, imipenem and amikacin. However, hospital-acquired isolates in general, as well as ESBL-positive isolates, exhibited lower susceptibilities than community-acquired isolates. Further surveillance monitoring of intra-abdominal isolates from India is recommended.

Guideline-Concordant Versus Discordant Antimicrobial Therapy in Patients With Community-Onset Complicated Intra-abdominal Infections

2016 ◽  
Vol 37 (7) ◽  
pp. 855-858 ◽  
Author(s):  
Lori L. Huang ◽  
Trevor C. Van Schooneveld ◽  
Robert D. Huang ◽  
Keith M. Olsen ◽  
Mark E. Rupp ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Infect Control Hosp ◽  
Active Therapy ◽  
Abdominal Infection ◽  
Guideline Compliance ◽  
Improved Outcomes ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Community Onset

Overall IDSA/SIS intra-abdominal infection guideline compliance was not associated with improved outcomes; however, there was a longer time to active therapy (P=.024) and higher mortality (P=.077) if empiric therapy was too narrow per guidelines. These findings support the need for the implementation of customized institutional guidelines adapted from the IDSA/SIS guidelines.Infect Control Hosp Epidemiol 2016;37:855–858

scholarly journals Outcome of Community- versus Hospital-Acquired Intra-Abdominal Infections in Intensive Care Unit: a Retrospective Study

2020 ◽  
Author(s):  
Timothée Abaziou ◽  
Fanny Vardon-Bounes ◽  
Jean-Marie Conil ◽  
Antoine Rouget ◽  
Stéphanie Ruiz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Apache Ii Score ◽  
Abdominal Infection ◽  
Hospital Stays ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Hospital Acquired

Abstract Background: To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications.Methods: Retrospective study including all patients admitted to 2 ICUs within 48 hours of undergoing surgery for peritonitis.Results: 226 patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7% and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15 – 25] vs. 21 [15 - 24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7 – 36] vs. 6[3 – 12] days, p < 0.001 and 41 [24 – 66] vs. 17 [7 – 32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI. Conclusion: CA-IAI group had higher 28-day mortality rate than HA IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.

scholarly journals Dynamics of changes in plasma fatty acid binding proteins and intestinal zonulin in patients with generalized intra-abdominal infection and abdominal sepsis depending on the severity of patients

2021 ◽  
Vol 88 (3-4) ◽  
pp. 46-53
Author(s):  
I. A. Kryvoruchko ◽  
M. O. Sykal
Keyword(s):  
Septic Shock ◽  
Fatty Acid ◽  
Binding Proteins ◽  
Abdominal Sepsis ◽  
Fatty Acid Binding Proteins ◽  
Control Group ◽  
Fatty Acid Binding ◽  
Abdominal Infection ◽  
Generalized Peritonitis ◽  
Intra Abdominal Infection

Objective. Determine the levels of plasma intestinal fatty acid binding proteins levels in combination with zonulin in patients with generalized intra-abdominal infection and abdominal sepsis, and define the clinical usefulness them to assess the severity of patients. Materials ad methods. This study was based on an analysis of 59 patients of both sexes aged 18 to 70 years with generalized intra-abdominal infection (gIAI) and abdominal sepsis (AS). Results. According to the aims and objectives of the study the patients were divided into three groups: the 1st group - 26 patients with generalized peritonitis without sepsis according to the «Sepsis-3» criterion; the 2nd group - 24 patients with sepsis, and the 3rd group - 9 patients with septic shock. We found statistically significant higher levels of I-FABP in the all groups of patients (P = 0.000). The same tendency was observed in all periods of the study, and the most significant levels of I-FABP were by the tenth day after surgery in patients with septic shock: IQR 1567.3- 3876.1 (P = 0.000). Patients with abdominal sepsis did not have a statistically significant change in zonulin levels compared to patients with gIAI without sepsis (P = 0.560) and a similar trend was observed on the 3rd day after surgery (P = 0.135). Only by the 7th and 10th days after surgery changes in zonulin levels were significant in intra-abdominal infection patients without sepsis, with abdominal sepsis and septic shock (P = 0.000 and P = 0.004, respectively). Conclusions. Serum I-FABP levels were valuable and objectively early predictors of the severity of gastrointestinal injuries in gIAI. We also presented evidence of increased plasma zonulin levels in generalized intra-abdominal infection compared with the control group. Elevated zonulin levels were an additional indicator of the observed increase in intestinal permeability during gIAI, but zonulin was not an early biomarker of the severity of gastrointestinal damage like I-FABP.

scholarly journals Utility of World Society of Emergency Surgery Sepsis Severity Score in Predicting Outcomes of Intra-abdominal Infections

2020 ◽  
Vol 17 (2) ◽  
pp. 65-68
Author(s):  
Kinyua Isaiah Mwenda ◽  
Daniel Ojuka ◽  
Mark Awori
Keyword(s):  
Emergency Surgery ◽  
Severity Score ◽  
Adult Population ◽  
Abdominal Sepsis ◽  
World Society ◽  
Adverse Outcomes ◽  
Source Control ◽  
Sepsis Severity ◽  
Unit Increase ◽  
Abdominal Infections

Background: Intra-abdominal infections are classified as simple or complicated. Many tools have been studied to predict risk factors and outcomes of patients with intra-abdominal infections. None of these tools has been adopted for patient care at the Kenyatta National Hospital (KNH), Kenya. Objective: To determine the utility of the World Society of Emergency Surgery (WSES) Sepsis Severity Score in predicting short-term outcomes of patients managed for complicated intra-abdominal infections. Methods: We conducted a hospital-based prospective cohort study. Patients aged 18 years and above with complicated intra-abdominal infections were recruited. Data were obtained on demographics, condition at admission, time to source control, origin of infection, immune suppressants and complications. IBM SPSS version 21.0 was used to obtain means and standard deviations while logistic regression was used for associations. Results: A sepsis severity score of 6.5, best predicted mortality having a sensitivity of 80% and a specificity of 20.9% were obtained. For each unit increase in the WSES scores, the odds of mortality were 2.1, organ dysfunction 2.2, CCU admission 2.1. Conclusion: Our sepsis severity score has demonstrated good performance in our adult population, and also ability to predict adverse outcomes other than mortality in patients managed for intra-abdominal sepsis. Keywords: WSES, Sepsis, Sepsis severity score, Intra-abdominal infections

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