Wilson S E, Hopkins J A
Department of Surgery, College of Medicine, University of California, Irvine, USA.
Clin Infect Dis. 1995 Jun;20 Suppl 2:S251-6. doi: 10.1093/clinids/20.supplement_2.s251.
Recent surgical reports indicate that for patients with secondary bacterial peritonitis, surgeons do not routinely use the identification of the bacterial pathogens and determination of their antimicrobial susceptibilities in choosing antimicrobial therapy. Further, some surgeons advocate abandoning the routine practice of obtaining culture specimens from patients with complicated appendicitis, because the data from the clinical laboratory have not been found to have an impact on postoperative care. We review the rationale for continued surveillance of and implementation of bacteriological data in treatment of secondary peritonitis. We also describe in detail the anaerobic flora of secondary peritonitis, the unique susceptibility patterns of these organisms, and the specific virulence factors of anaerobes, particularly Bacteroides fragilis. The fact that clinical investigations sometimes result in treatment failure when gram-negative anaerobes are resistant to the antimicrobials used or when complete antimicrobial susceptibility data are not available emphasizes the need for accurate and early knowledge of the bacteriologic characteristic of the flora of the operative site. We emphasize the relationship of in vitro susceptibility of intraoperative isolates with clinical outcome. We propose a cooperative trial that would demonstrate that successful antimicrobial therapy should be based on the susceptibility of the flora of the operative site, which correlates with clinical outcome.
近期的外科手术报告表明，对于继发性细菌性腹膜炎患者，外科医生在选择抗菌治疗时通常不会常规进行细菌病原体鉴定及其药敏试验。此外，一些外科医生主张放弃对复杂性阑尾炎患者常规采集培养标本的做法，因为临床实验室的数据并未被发现对术后护理有影响。我们回顾了在继发性腹膜炎治疗中持续监测和应用细菌学数据的理论依据。我们还详细描述了继发性腹膜炎的厌氧菌群、这些微生物独特的药敏模式以及厌氧菌（特别是脆弱拟杆菌）的特定毒力因子。当革兰氏阴性厌氧菌对所用抗菌药物耐药或无法获得完整的药敏数据时，临床研究有时会导致治疗失败，这一事实强调了准确且早期了解手术部位菌群细菌学特征的必要性。我们强调术中分离菌株的体外药敏与临床结果之间的关系。我们提议开展一项合作试验，以证明成功的抗菌治疗应基于手术部位菌群的药敏情况，而这与临床结果相关。
