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

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

Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.
Appendicitis ; Bacteremia ; Bacteroides ; Bacteroides fragilis ; Cholecystitis, Acute ; Diverticulitis ; Early Diagnosis ; Humans ; Inflammatory Bowel Diseases ; Intraabdominal Infections ; Pancreatitis ; Portal Vein ; Prognosis ; Rare Diseases ; Streptococcus ; Stress, Psychological ; Thrombophlebitis ; Viridans Streptococci

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.
Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Bacteria ; Bacteroides fragilis ; Cavernous Sinus Thrombosis ; Diverticulitis ; Early Diagnosis ; Escherichia coli ; Humans ; Intraabdominal Infections ; Mesenteric Veins ; Portal Vein ; Thrombophlebitis

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.
Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Bacteria ; Bacteroides fragilis ; Cavernous Sinus Thrombosis ; Diverticulitis ; Early Diagnosis ; Escherichia coli ; Humans ; Intraabdominal Infections ; Mesenteric Veins ; Portal Vein ; Thrombophlebitis

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: 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

PURPOSE: We assessed the feasibility and efficacy of a laparoscopic approach in surgically managing various conditions of the acute abdomen. METHODS: This report presents preliminary data from our ongoing prospective study. Sixty patients underwent a diagnostic or a therapeutic laparoscopy for acute or subacute abdominal conditions between July 1997 and September 1998. RESULTS: Conditions were classified into trauma (n=8), peritonitis (n=41), and obstruction (n=11). Trauma included 5 blunt (2 small bowel perforations, 1 spleen rupture, 2 mesenteric ruptures) and 3 stab injuries. Peritonitis included 23 duodenal ulcer perforations, 10 acute cholecytitis/empyema, 3 colon perforations, 1 tuberculous peritonitis, 1 ectopic pregnancy, 1 ruptured corpus luteum, 1 appendicitis, and 1 ruptured liver abscess. Obstruction included 5 intussusceptions (4 Children, 1 adult), 2 intestinal adhesions; and 4 congenital hypertropic pyloric stenoses. Among the 54 cases of therapeutic laparoscopy, 9 cases were converted during the procedure (conversion rate: 16.7%). There were 2 intraoperative (bowel perforation) and 4 postoperative (1 subphrenic abscess, 1 incomplete adhesiolysis, 1 port site hernia, 1 port-site seroma) complications. CONCLUSION: Our preliminary data may justify further clinical study to clarify the role of laparoscopy in managing acute or subacute abdominal conditions.
Abdomen, Acute* ; Appendicitis ; Child ; Colon ; Constriction, Pathologic ; Corpus Luteum ; Duodenal Ulcer ; Female ; Hernia ; Humans ; Intussusception ; Laparoscopy* ; Liver Abscess ; Peritonitis ; Peritonitis, Tuberculous ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Rupture ; Spleen ; Subphrenic Abscess

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.
Abdominal Pain ; Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Diarrhea ; Drainage ; Humans ; Intraabdominal Infections ; Jaundice ; Mesenteric Veins ; Portal System ; Portal Vein ; Thrombosis