Levin S, Goodman L J
Am J Med. 1985 Nov 29;79(5B):146-56. doi: 10.1016/0002-9343(85)90149-4.
True prophylaxis of intra-abdominal nongynecologic infections is limited to elective, nonemergency surgery and is best shown in three clean-contaminated surgical procedures. All of these have an infection rate of approximately 10 to 20 percent and include all colon resection surgery, most gastric surgery, and about one third of the cholecystectomies for chronic calculous cholecystitis. Each of these three surgical procedures has a somewhat different pattern of bacterial pathogens. The most useful comparative studies of early preoperative therapy have been performed in cases of suspected appendicitis (50 percent of which usually show perforation or gangrene at the time of surgery) and penetrating abdominal wounds (80 percent of which usually enter some part of the bowel and theoretically soil the peritoneum). These procedures are usually classified as contaminated, with a 20 to 30 percent infection rate, or dirty, with a more than 30 percent infection rate, depending upon several factors. Comparative investigations of intraoperative and postoperative antibiotic therapy of established intra-abdominal infections are more difficult to obtain because of the heterogeneity of the sites, organisms, and medical and surgical therapy. The initial pathogens causing secondary peritonitis and hepatic, perirectal, diverticular, and most other types of intraperitoneal abscesses are mixed coliforms and anaerobes, with emphasis on the anaerobes. Retroperitoneal abscesses, pancreatic abscesses, and biliary tract infections are predominantly caused by coliforms. The organisms responsible for these early infections are usually community-acquired rather than more antibiotic-resistant hospital-acquired bacteria. Considering the availability of a large number of effective broad-spectrum antibacterial agents and therapeutic combinations, it has become increasingly difficult to assess the rightful place of any new prospective antimicrobial regimen unless it has quite unique characteristics. Most empiric therapy in established intra-abdominal infection studies have compared gentamicin and clindamycin, the most popular regimen in the United States over the past 15 years, with a cephalosporin, broad-spectrum penicillin, or aminoglycoside, either alone or together with clindamycin or metronidazole. Results have usually been considered similar in most studies, although in some studies, agents with limited Bacteroides fragilis activity, such as cefamandole or cefaperazone, have been considered inferior. Most new prophylactic regimens have been compared with the first-generation cephalosporins and, again, similar results have been obtained between the groups with two exceptions. Cepha
真正预防腹腔内非妇科感染仅限于择期非急诊手术，在三种清洁-污染手术中预防效果最佳。所有这些手术的感染率约为10%至20%，包括所有结肠切除术、大多数胃手术以及约三分之一的慢性结石性胆囊炎胆囊切除术。这三种手术中的每一种都有 somewhat 不同的细菌病原体模式。早期术前治疗最有用的比较研究是在疑似阑尾炎（其中50%在手术时通常显示穿孔或坏疽）和穿透性腹部伤口（其中80%通常进入肠道的某个部位并理论上污染腹膜）的病例中进行的。根据几个因素，这些手术通常分为污染手术（感染率为20%至30%）或脏手术（感染率超过30%）。由于感染部位、微生物以及内科和外科治疗的异质性，对已确诊的腹腔内感染进行术中及术后抗生素治疗的比较研究更难获得。引起继发性腹膜炎以及肝、直肠周围、憩室和大多数其他类型腹腔脓肿的初始病原体是混合的大肠菌群和厌氧菌，重点是厌氧菌。腹膜后脓肿、胰腺脓肿和胆道感染主要由大肠菌群引起。这些早期感染的病原体通常是社区获得性的，而不是更具抗生素耐药性的医院获得性细菌。考虑到有大量有效的广谱抗菌剂和治疗组合可供使用，除非新的前瞻性抗菌方案具有相当独特的特性，否则越来越难以评估其应有的地位。在已确诊的腹腔内感染研究中，大多数经验性治疗都将庆大霉素和克林霉素（过去15年在美国最常用的方案）与头孢菌素、广谱青霉素或氨基糖苷类药物进行了比较，这些药物单独使用或与克林霉素或甲硝唑联合使用。在大多数研究中，结果通常被认为相似，尽管在一些研究中，对脆弱拟杆菌活性有限的药物，如头孢孟多或头孢哌酮，被认为效果较差。大多数新的预防方案都与第一代头孢菌素进行了比较，同样，两组之间除了两个例外都得到了相似的结果。头孢
