No abstract available.
APACHE* ; Emergencies* ; Intraabdominal Infections*

The incidence of intra-abdominal infection increases annually. The current management of intra-abdominal infection includes immediate resuscitation, prompt source control and appropriate usage of antibiotics. For patients with septic shock, fluid resuscitation should begin immediately when hypotension is present. Fluid resuscitation should be combined with vasoactive drugs. Damage control surgery promotes the development of ultrasound or CT guided percutaneous abscess drainage and open abdomen therapy. Rational use of anti-infective drugs could prevent prevalence of multiple antibiotics resistant bacteria and pan-resistant bacteria. The gut rehabilitation measures can improve the recovery of gut function and restore of enteral nutrition, and thus prevents bacterial translocation in intra-abdominal infection patients. Monitoring and modulations of immune function may further improve the successful rate of treatment of intra-abdominal infections. Non-thyroidal illness syndrome may develop in the severe intra-abdominal infection patients and should be promptly corrected.
Humans ; Intraabdominal Infections ; diagnosis ; therapy

PURPOSE: To determine the usefulness of the Sequential Organ Failure Assessment (SOFA) score for prediction of mortality in operated patients with sepsis due to intra-abdominal infection. METHODS: Eighty-eight septic patients operated on from January 2004 to June 2008 were evaluated retrospectively. The SOFA scores were measured four times in each patient: initial score, post-op (post-operation) score, POD1 (first post-operative day) score, and POD2 (second post-operative day) score. The maximum score and mean score were obtained from these measurements. These scores were compared between groups of patients classified by mortality. D scores (D0, D1, D2) reflecting the differences between subsequent scores were compared between the surviving group and deceased group according to re-operation. RESULTS: The initial, post-op, POD1, POD2, maximum, and mean scores showed statistically significant differences between the surviving group and deceased group. D1 and D2 showed statistically significant differences between surviving group and deceased group. CONCLUSION: The sequential measurement of SOFA score is a useful prediction system for patients with sepsis due to intra-abdominal infection.
Humans ; Intraabdominal Infections ; Retrospective Studies ; Sepsis

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Abscess ; Adult* ; Appendicitis ; Ceftriaxone* ; Humans ; Intraabdominal Infections* ; Metronidazole* ; Prospective Studies

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Abscess ; Adult* ; Appendicitis ; Ceftriaxone* ; Humans ; Intraabdominal Infections* ; Metronidazole* ; Prospective Studies

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.
Arthritis ; Bacillus ; Catheter-Related Infections ; Corynebacterium ; Endocarditis ; Intraabdominal Infections ; Membranes ; Meningitis ; Skin

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.
Arthritis ; Bacillus ; Catheter-Related Infections ; Corynebacterium ; Endocarditis ; Intraabdominal Infections ; Membranes ; Meningitis ; Skin

PURPOSE: Laparoscopic appendectomy (LA) has become a gold standard for children even in complicated appendicitis. The purpose of this study was to compare the postoperative surgical site infection rates between laparoscopic and open appendectomy (OA) group in pediatric complicated appendicitis. METHODS: A total of 1,158 pediatric patients (age < or =15 years) underwent operation for appendicitis over a period of 8 years. Among these patients, 274 patients (23.7%) were diagnosed with complicated appendicitis by radiologic, operative and pathologic findings, and their clinical outcomes were retrospectively analyzed. RESULTS: Of the 274 patients with complicated appendicitis, 108 patients underwent LA and 166 patients underwent OA. Patients in the LA group returned to oral intake earlier (1.9 days vs. 2.7 days; p<0.01) and had a shorter hospital stay (5.0 days vs. 6.3 days; p<0.01). However, rate of postoperative intra-abdominal infection (organ/space surgical site infection) was higher in the LA group (LA 15/108 [13.9%] vs. OA 12/166 [7.2%]; p<0.01). Readmission rate was also higher in the LA group (LA 9/108 [8.3%] vs. OA 3/166 [1.8%]; p<0.01). CONCLUSION: The minimally invasive laparoscopic technique has more advantages compared to the open procedure in terms of hospital stay and early recovery. However, intra-abdominal infection and readmission rates were higher in the laparoscopy group. Further studies should be performed to evaluate high rate of organ/space surgical infection rate of laparoscopic procedure in pediatric complicated appendicitis.
Appendectomy ; Appendicitis* ; Child ; Humans ; Intraabdominal Infections ; Laparoscopy* ; Length of Stay ; Postoperative Complications ; Retrospective Studies

Rapidly increasing antimicrobial resistance and lack of effective antibiotics are dilemma in the treatment of infectious diseases. Clinicians are now considering the use of old antibiotics such as colistin, fosfomycin because of limitation of therapeutic options. The unique pharmacokinetic and pharmacodynamics properties of these antibiotics have led the new therapeutic approaches, such as the combination of agents and newer dosing regimens. Colistin has become the last drug of the treatment of multidrug resistant gram-negative bacteria and the loading dose and high dose maintenance has been suggested. Tigecycline is licensed for the treatment of complicated skin and intra-abdominal infections and has broad activity against gram-positive and gram-negative pathogens but cautious use in the treatment of bloodstream infection and pneumonia is recommended. Oral and intravenous fosfomycin may be effective treatment options in the case of resistant gram-negative infections but clinical studies are limited.
Anti-Bacterial Agents ; Bacteria* ; Colistin ; Communicable Diseases ; Fosfomycin ; Gram-Negative Bacteria ; Intraabdominal Infections ; Pneumonia ; Skin

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).