Hasper Dietrich, Schefold Joerg C, Baumgart Daniel C
Division of Nephrology & Critical Care Medicine, Charité Medical Center - Virchow Hospital, Medical School of the Humboldt-University of Berlin, Berlin, Germany.
Recent Pat Antiinfect Drug Discov. 2009 Jan;4(1):57-65. doi: 10.2174/157489109787236265.
Abdominal infections are associated with significant morbidity and mortality. Nearly all bacteria causing abdominal infections are derived from the endogenous flora of the alimentary tract. The resulting infection is typically polymicrobial and comprised of both aerobic and anaerobic microbes. They can be classified by their severity as uncomplicated and complicated or by their origin as community or hospital acquired. Escherichia coli and Bacteroides fragilis are the most frequently isolated bacteria in community-acquired abdominal infections. Nosocomial infections typically involve a more resistant flora (e.g. Pseudomonas spp., Acinetobacter spp., Gram-negative bacilli producing extended-spectrum beta-lactamases [ESBL], vancomycin-resistant enterococci [VRE] and methicillin-resistant Staphylococcus aureus [MRSA]). Antimicrobial therapy should be guided by microbiological testing and frequently requires other interventions as well. In uncomplicated infections antimicrobial prophylaxis for < 24h may be considered. Patients with underlying or acquired immunodeficiency, i.e. organ transplant recipients and other patients on complex immunosuppressant regimens require special attention and antimicrobial coverage. We discuss the relevant microbiota, a rational diagnostic and therapeutic approach including strategies to handle challenging infections. The application of novel compounds and/or drug classes for abdominal infections such as glycylcyclines (i.e. tigecycline), glycopeptides (i.e. dalbavancin, telavancin, oritavancin), carbapenems (i.e. doripenem), and forth generation cephalosporins (i.e. ceftaroline, ceftobiprole) as well as patents on metalloproteinase and caspase inhibitors, interleukin antagonists, fusion proteins and nitric oxide donators is critically reviewed. The information is summarized in flow charts and algorithms for use in daily clinical practice and the review article also shows the useful information of the patents for the treatment of abdominal infections.
腹部感染与显著的发病率和死亡率相关。几乎所有引起腹部感染的细菌都源自消化道的内源性菌群。由此产生的感染通常是多微生物的，由需氧菌和厌氧菌组成。它们可根据严重程度分为非复杂性和复杂性，或根据来源分为社区获得性或医院获得性。大肠埃希菌和脆弱拟杆菌是社区获得性腹部感染中最常分离出的细菌。医院感染通常涉及更具耐药性的菌群（如假单胞菌属、不动杆菌属、产超广谱β-内酰胺酶的革兰阴性杆菌、耐万古霉素肠球菌和耐甲氧西林金黄色葡萄球菌）。抗菌治疗应以微生物检测为指导，通常还需要其他干预措施。在非复杂性感染中，可考虑进行<24小时的抗菌预防。有基础或获得性免疫缺陷的患者，即器官移植受者和其他接受复杂免疫抑制方案的患者，需要特别关注和抗菌覆盖。我们讨论了相关的微生物群、合理的诊断和治疗方法，包括处理具有挑战性感染的策略。对用于腹部感染的新型化合物和/或药物类别（如甘氨环素类，即替加环素；糖肽类，即达巴万星、特拉万星、奥利万星；碳青霉烯类，即多利培南；第四代头孢菌素类，即头孢洛林、头孢托罗）以及金属蛋白酶和半胱天冬酶抑制剂、白细胞介素拮抗剂、融合蛋白和一氧化氮供体的专利进行了严格审查。信息总结在流程图和算法中，以供日常临床实践使用，并且该综述文章还展示了治疗腹部感染的专利的有用信息。
