Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62100, Italy.
Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
World J Emerg Surg. 2024 Jun 8;19(1):22. doi: 10.1186/s13017-024-00552-9.
Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient's clinical condition, and the host's immune status should be assessed continuously to optimize the management of patients with complicated IAIs.
腹腔内感染(IAIs)是全球医院环境中发病率和死亡率的重要原因。IAI 管理的基石包括快速、准确的诊断;及时、充分的源头控制;根据药代动力学/药效学和抗菌药物管理原则,给予适当、短疗程的抗菌治疗;以及通过静脉补液和辅助血管加压药物对严重疾病(败血症/器官功能障碍或纠正血容量不足后的败血症性休克)进行血流动力学和器官功能支持。在患有 IAI 的患者中,采用个性化方法对于优化治疗结果至关重要,并且应该基于需要仔细临床评估的多个方面。感染的解剖范围、涉及的假定病原体和对抗菌药物耐药性的危险因素、感染的来源和范围、患者的临床状况以及宿主的免疫状态应持续评估,以优化复杂 IAI 患者的管理。