Weiss G, Meyer F, Lippert H
Department of Surgery, University Hospital, Magdeburg, Germany.
Langenbecks Arch Surg. 2006 Sep;391(5):473-82. doi: 10.1007/s00423-006-0071-3. Epub 2006 Aug 15.
The tertiary peritonitis causes the highest mortality in intraabdominal infections. Surgical interventions and antibiotic therapy may only provide an incomplete impact on nosocomial infections acquired at an intensive care unit (ICU) [Nathens et al., World J Surg 22:158-163, 28]. To open up new resources in the management, in particular, in the previous infectious diagnostic, the aim was to investigate the infectious course as well as the diagnostic value of laboratory parameters and microbiological monitoring.
In this retrospective patient cohort study from the Surgical ICU of a University Hospital (capacity, n=12), overall, 60 patients with a tertiary peritonitis were enrolled.
Approximately 20% of the patients with an intraabdominal infection developed a tertiary peritonitis. A tertiary peritonitis can more frequently develop in nosocomial intraabdominal infections, in particular, in case of necrotizing pancreatitis. The device-associated infection rate in the spectrum of nosocomial infections is sevenfold higher than in all ICU patients. Compared with the secondary peritonitis, its mortality is double as high: 35%. In the diagnostic characterizing the course of the nosocomial, prognosis-relevant infections, usual inflammatory parameters show a considerable loss of their sensitivity with a range from 35-57%. By the mean of a routine microbiological monitoring, 47.3% of the analysed subsequent infections could be identified at an early stage.
In patients with a severe infection, an early diagnostic and treatment of infectious "second hits" can improve the complication rate and prognosis. During the prolonged and complicated septic course of tertiary peritonitis, an additional routine microbiological monitoring contributed effectively to early detection and diagnostic of nosocomial infections. Further studies to investigate the value and efficacy of such monitoring, which have been abandoned, should be undertaken in infectious high-risk patients.
在腹腔内感染中，三期腹膜炎导致的死亡率最高。手术干预和抗生素治疗可能仅对重症监护病房（ICU）获得的医院感染产生不完全的影响[纳森斯等人，《世界外科杂志》22:158 - 163，28]。为了在管理方面，特别是在先前的感染诊断中开拓新资源，目的是研究感染过程以及实验室参数和微生物监测的诊断价值。
在这项来自一所大学医院外科ICU（容量，n = 12）的回顾性患者队列研究中，总共纳入了60例三期腹膜炎患者。
腹腔内感染患者中约20%发展为三期腹膜炎。三期腹膜炎更常发生在医院获得性腹腔内感染中，尤其是在坏死性胰腺炎的情况下。医院感染范围内与器械相关的感染率比所有ICU患者高7倍。与二期腹膜炎相比，其死亡率高出一倍：为35%。在表征医院感染病程、与预后相关的感染的诊断中，常用的炎症参数显示其敏感性大幅下降，范围为35% - 57%。通过常规微生物监测手段，47.3%的分析后续感染能够在早期被识别。
在严重感染患者中，对感染性“二次打击”进行早期诊断和治疗可改善并发症发生率和预后。在三期腹膜炎漫长而复杂的脓毒症病程中，额外的常规微生物监测有效地促进了医院感染的早期检测和诊断。对于此类已被摒弃的监测的价值和疗效的进一步研究，应在感染高危患者中进行。
