Elsakr R, Johnson D A, Younes Z, Oldfield E C
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk 23502, USA.
Dig Dis. 1998 Jan-Feb;16(1):47-60. doi: 10.1159/000016848.
There have been several recent changes that influence the management of intra-abdominal infections. These changes include important developments in antibiotic resistance such as increases in pneumococcal resistance, emergence of multi-drug-resistant enterococcal isolates, and decreasing sensitivity of anaerobes and gram-negative rods. In addition there are new antibiotics such as piperacillin/tazobactam, and new antibiotic dosing regimens such as single daily dosing of aminoglycosides. In this article, we will review the therapeutic approach to intra-abdominal infections with special emphasis on the various forms of peritonitis, cholecystitis, cholangitis, and diverticulitis. Several new concepts about the treatment of enterococcus, the management of bacterial and fungal peritonitis, and the prevention of spontaneous bacterial peritonitis will also be reviewed. Specific recommendations for the management of the different infections including antibiotic doses and costs will be provided. Finally the role of invasive procedures in the management of some of the infections will be explored.
近期出现了一些影响腹腔内感染管理的变化。这些变化包括抗生素耐药性方面的重要进展，如肺炎球菌耐药性增加、多重耐药肠球菌分离株的出现，以及厌氧菌和革兰氏阴性杆菌敏感性降低。此外，还有新的抗生素，如哌拉西林/他唑巴坦，以及新的抗生素给药方案，如氨基糖苷类药物每日单次给药。在本文中，我们将回顾腹腔内感染的治疗方法，特别强调各种形式的腹膜炎、胆囊炎、胆管炎和憩室炎。还将回顾关于肠球菌治疗、细菌性和真菌性腹膜炎管理以及自发性细菌性腹膜炎预防的几个新概念。将提供针对不同感染管理的具体建议，包括抗生素剂量和费用。最后，将探讨侵入性操作在某些感染管理中的作用。
