empiric treatment options in the management of complicated
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Empiric Treatment Options In The Management Of Complicated Intra-Abdominal Infections
Pembimbing:
dr.Bambang Arianto,Sp.B
Oleh :
Eka Mahyunie
UNIVERSITAS MUHAMMADIYAH MALANGFAKULTAS KEDOKTERAN
2011
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Introduction Because of their association with high rates
of morbidity and mortality, intra-abdominal infections surgeons and internists
Source control (surgical measures to eradicate a focus of infection, prevent ongoing microbial contamination, and restore functional anatomy) is fundamental to the management of patients with complicated intra-abdominal infections
Empiric antimicrobial therapy important in the overall management plan
this review focuses on criteria for choosing empiric antimicrobial therapy for complicated infections
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Causes And Classification Of Intra-Abdominal Infections
aerobic and anaerobic bacteria causes for the development of intra-abdominal infections.
Intra-abdominal infections generally occur because a normal anatomic barrier is disrupted
peritonitis used synonymously for intra-abdominal infections.
Intra-abdominal infections also can be described as:◦ primary infections usually do not involve a hollow viscus◦ secondary infections are associated with hollow viscus
perforations◦ Tertiary infections are associated with
immunocompromised patients and usually involve treatment failures
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intra-abdominal infectionsmortality rates still can vary widely depending on the source of the infection, ranging from 0.25% for the appendix to much higher rates for the stomach/duodenum (21%), pancreas (33%), small bowel (38%), large bowel (45%), and biliary tract (50%).
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RISK STRATIFICATION
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BACTERIOLOGYcause intra-abdominal infections
from the endogenous flora of the gastrointestinal tract.
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Type/site of infection and acquisition mode indicate likely pathogens
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GENERAL TREATMENT APPROACHFluid resuscitationsource control (ie, surgical
debridement, drainage, and repair)
systemic antibacterial source control must be
considered paramountantibiotics will not successfully treat a patient with secondary or tertiary peritonitis
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ANTIMICROBIAL SELECTION AND USEAvoid inappropriate use
◦Patients with bowel injuries due to penetrating, blunt, or iatrogenic trauma that are repaired within 12 hours should receive only short-course (perioperative) antimicrobial therapy.
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Factors that influence antimicrobial selection
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Available antimicrobial options◦monotherapy with imipenem/cilastatin
(Primaxin) gold standard because of its broad spectrum
◦ampicillin/ sulbactam, ticarcillin clavulanate (Timentin), and piperacillin/tazobactam (Zosyn), meropenem (Merrem), ertapenem (Invanz), and tigecycline (Tygacil) effective as monotherapy
◦oral antibiotics (eg, ciprofloxacin, amoxicillin/clavulanate)
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ANTIMICROBIAL TREATMENT
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NEWER THERAPEUTIC OPTIONSTigecycline imipenem/cilastatinDoripenem
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DURATION OF ANTIMICROBIAL THERAPYA final issue of importance to the
use of antibiotics duration of treatment
Excessive or prolonged therapy is considered to be one driver of bacterial resistance.
An antimicrobial regimen for intra-abdominal infection should be continued 5 to 7 days.
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SUMMARY AND CONCLUSIONS
Source control remains the most important component in the successful treatment of complicated intraabdominal infections
Proper selection of empiric antibiotic therapy is adjunctive but is still important to the overall treatment plan
Selection of empiric antimicrobial therapy for complicated intraabdominal infections depends on the severity of the illness and how the infection was acquired.
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Thank’s…………………..