Klinikum Peine gGmbH, Academic Hospital of Medical University Hannover, Virchowstrasse 8h, 31226 Peine, Germany.
Eur J Med Res. 2011 Mar 28;16(3):115-26. doi: 10.1186/2047-783x-16-3-115.
Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates). From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative) and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. - The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Furthermore, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or necrotizing pancreatitis) to provide specific recommendations for such antimicrobial treatment. - A panel of European colleagues from surgery, intensive care, clinical microbiology and infectious diseases has developed recommendations based on the above mentioned clinical entities with the aim of providing clear therapeutic recommendations for specific clinical diagnoses. An individual patient-centered approach for this very important group of diseases with a substantial morbidity and mortality is essential for optimal antimicrobial treatment.
最近，IDSA 发布了治疗复杂腹腔内感染的指南更新版。没有任何指南可以涵盖所有国家不同的生态、抗生素耐药模式、患者特征和表现、医疗保健和报销系统的变化。在 IDSA 指南可用的短短时间内，医生就指南的解释提出了一些实际的临床问题。新 IDSA 指南的主要争议问题如下：IDSA 指南的作者为以下“复杂”IAI 的亚组提出了建议：轻度至中度和高度严重程度的社区获得性腹腔内感染和与医疗保健相关的腹腔内感染（无一般治疗建议，仅提供特定耐药细菌分离株的抗菌治疗信息）。从临床角度来看，“复杂”IAI 最好分为原发性、继发性（社区获得性和术后）和三级腹膜炎。这些是在急诊室、普通病房和 ICU 看到的 IAI 的临床表现。如果将患者纳入治疗 IAI 的抗生素疗效和安全性研究中，而不是基于“复杂”IAI 的模糊术语进行研究，那么 IAI 的未来抗生素治疗研究将更具临床相关性。 - 新的 IDSA 治疗耐药菌的指南未能提及许多新的可用药物，尽管存在治疗新物质治疗“复杂 IAI”的临床数据。此外，也不包括 VRE 引起的 cIAI 的治疗建议。该疾病组包含足够的患者（即所有术后和三级腹膜炎、胆管手术或坏死性胰腺炎的再次干预），可为此类抗菌治疗提供具体的治疗建议。 - 一组来自外科、重症监护、临床微生物学和传染病学的欧洲同事根据上述临床实体制定了建议，旨在为特定的临床诊断提供明确的治疗建议。对于发病率和死亡率都很高的这一非常重要的疾病群体，采用个体化、以患者为中心的方法进行治疗对于最佳抗菌治疗至关重要。
