1 / 26

Intraabdominal Infections

Intraabdominal Infections. Resat Ozaras, MD, Prof. Infection Dept. rozaras@yahoo.com. Peritonitis Inraabdominal abscess Liver and biliary system inf. Pancreas infections Splenic inf. Appendicitis and diverticulitis. Approach.

cthorne
Download Presentation

Intraabdominal Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intraabdominal Infections Resat Ozaras, MD, Prof. Infection Dept. rozaras@yahoo.com

  2. Peritonitis Inraabdominal abscess Liver and biliary system inf. Pancreas infections Splenic inf. Appendicitis and diverticulitis

  3. Approach • Abd. pain, fever, tenderness, leukocytosis intraabdominal inf.? • History and PE • Surgery consultation • Emprical Tx • Culture (blood, peritoneal fluidı...) + other studies

  4. Peritonitis • Primary peritonitis • Secondary peritonitis • Tertiary peritonitis

  5. Primaryperitonitis 1. Spontaneous peritonitis in children (<1-2%) postnecrotic cirrhosis, nephrotic syndrome 2. Spontaneous peritonitis in adults (10-30% of hospitalised cirrhotics) alcoholic cirrhosis, postnecrotic cirrhosis, viral hepatitis, heart failure, metastasis, autoimmune… 3. Tuberculous peritonititis

  6. Microbiology 70% enteric pathogens • Escherichia coli • Klebsiella pneumoniae • Streptococcus pneumoniae • Enterococci • Staphylococcus aureus (rare) • Anaerops For anaerobs, 75% bacteremia

  7. Hematogenous Lymphatic transmural migration through GI tract Vaginal Through Fallopian tubes Pathogenesis

  8. S&S • Acute fever • Abd. pain • Nausea, vomiting • Tenderness, rebound • Hypoactive bowel sounds

  9. In patients with ascites, peritoneal irritation findings may not be seen • Fever >37.8˚C

  10. TB peritonitis • Fever • Weight loss • Fatigue • Night sweats • Abdominal distension • Multiple nodules on peritoneum and omentum (in laparoscopy)

  11. Laboratuvar • In ascitis fluid Cell count (>250 PMN/mm3, > 500 leukocyte/mm3) Protein (serum-ascites albumin gradient <1,1) LDH (ascites/serum >0,4) Gram Staining (60-80% negative) Culture (40% negative)

  12. CT: to exclude any primary focus of intaabdominal inf. • Response to emprical antibiotics within 48-72 h.

  13. Tx • Emprical ampicillin+aminoglycoside 3rd gen. Ceph. piperacilin piperacilin-tazobactam, ampicillin- sulbactam carbapenems levofloxacine, moxifloxacin

  14. Secondary peritonitis • The integrity of GI tract is broken • Etiology depend upon the damaged site • Polymicrobial • E.coli (early mortality) • B. fragilis (late abscess development)

  15. Secondary peritonitis • Gastrointestinal perforation (appendicitis, gastroduodenal ulcer perforation, cancer perforation, bile duct perforation…) • Intestinal ischemia-perforation (mesenteric occlusion, strangulation of hernia) • Postoperative peritonitis (anastomosis leak, blind loop leak, iatrogenic peroperative damages)

  16. 4. Posttraumatic peritonitis (penetrating, blunt trauma) 5. Pelvic peritonitis (septic abortus, puerperal sepsis, salpyngitis, purulant prostatitis)

  17. Aerops Escherichiacoli %65 Proteusspp. %25 Klebsiellaspp. %20 Pseudomonasspp. %15 Enterococcir %15 Streptococcir %10 Anaerops Bacteroidesfragilis %80 Bacteroidesspp. %30 Clostridiumspp. %65 Peptostreptococcusspp. %25 Peptococcusspp. %15 Fusobacteriumspp. %20 Microbiology

  18. Clinical • Abd. pain (severe on the inflamed site, increases on movement), anorexia, nausea, vomiting, dehydration due to hypovolemia, chills, fever. • Hypotention, tachycardia, oliguria, tachypnea (due to hypovolemia, hypoxia, and acidosis • Adynamic ileus

  19. Tenderness, guarding, rebound: helpful for localising the site and the diagnosis. • Bowel sounds: initially hyperactive then silence….

  20. Dx • Leukocytosis, left-shift (stabs) • Hemoconcentration and dehydration: high hematocrit and BUN • High ALT/AST, low platelets, acidosis, high D-dimer • Plain abdominal X-ray, chest X-ray • Abdominal US, CT • Surgical or CT-guided sample: gram and culture, BC (20-30% bacteremia)

  21. Prognosis • Age • Co-morbidity • Peritoneal contamination time • “Foreign” substance (biliary and pancreatic secretions) • Microorganism • Mortality: 3.5-60%

  22. Tx • Surgery + supportive+ antibiotics (leukocytes, fever, bowel sounds…) • 5- 7 days after an appropriate surgical control

  23. Ampirik antibiyoterapi • Community-acq. mild-moderatecefazolin+metronidazol severe piperacillin-tazobactam ceftriaxon+metronidazol clindamicin+gentamicin imipenem • Hospitalacq. piperacillin+metronidazol +aminoglycoside imipenem+/-aminoglycoside Enterokococci , Candida ??

  24. Treatment Guidelines for Intra-abdominal Infections • CID 2003:37 (15 October)

More Related