•JOHN A. WEIGELT, MD,Empiric treatment options in the management of complicated intra-abdominal infections CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 74 • SUPPLEMENT 4 AUGUST 2007
IDSA, the Surgical Infection Society, the American Society for Microbiology, and the Society of Infectious Disease Pharmacists,Guidelines for the Selection of Antiinfective Agents for Complicated Intra-abdominal Infections，CID2003, 37:997–1005
MEDICINE VOLUME 74 • SUPPLEMENT 4 AUGUST 2007
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细菌性腹膜炎分类
原发性腹膜炎 继发性腹膜炎 第三型腹膜炎
•JOHN A. WEIGELT, MD,Empiric treatment options in the management of complicated intra-abdominal infections CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 74 • SUPPLEMENT 4 AUGUST 2007
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腹腔感染(IAI)概述
过去一个世纪IAI治疗取得巨大进步，死亡率显著 下降 90% in 1900 to 23% in 2002
IAI不同来源感染的死亡率 appendix (0.25%) stomach/duodenum (21%) pancreas (33%) small bowel (38%) large bowel (45%) biliary tract (50%)
Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children:Guidelines by the Surgical Infection Societyand the Infectious Diseases Society of America；Clinical Infectious Diseases 2010; 50:133–64
Infectious Diseases Society of Taiwan; Taiwan Surgical Society of Gastroenterology,etal,Guidelines for antimicrobial therapy of intra-abdominal infections in adults, J Microbiol Immunol Infect. 2008;41:279-281
complicated intra-abdominal infections. Drugs. 2005;65(12):1611-20
•JOHN A. WEIGELT, MD,Empiric treatment options in the management of
complicated intra-abdominal infections CLEVELAND CLINIC JOURNAL OF
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复杂腹腔感染(cIAI)
复杂腹腔感染(cIAI) 通常定义为空腔脏器的 内容穿入腹腔导致局限性腹膜炎(包括脓肿)、 弥漫性腹膜炎
感染源经外科处理后，仍残留细菌，需使 用抗感染药物
cIAI 更多地与不良预后相关，其最大挑战 是早期识别
Blot S, De Waele JJ. Critical issues in the clinical management of
•JOHN A. WEIGELT, MD,Empiric treatment options in the management of
பைடு நூலகம்
complicated intra-abdominal infections, cleveland clinic journal of medicine
volume 74 • supplement 4 august 2007
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Uncomplicated IAI
单纯性腹腔感染仅累及1个器官,而且没有解 剖结构的破坏
通常病灶可完全切除，仅需预防性使用抗 菌药物
Blot S, De Waele JJ. Critical issues in the clinical management of complicated intra-abdominal infections. Drugs. 2005;65(12):1611-20
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IAI定义分类
f. M. pieracci, p. S. barie,ManageMent of Severe SepSiS of abdoMinal origin,
Scandinavian Journal of Surgery 96: 184–196, 2007
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单纯腹腔感染 复杂腹腔感染
Intra-abdominal infections also can be categorized as uncomplicated versus complicated, although the distinction is not always clear
复杂腹腔感染
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IAI相关指南
the Therapeutic Agents Committee of the Surgical Infection Society,The Surgical Infection Society Guidelines on Antimicrobial Therapy for Intra-Abdominal Infections:An Executive Summary,SURGICAL INFECTIONS Volume 3, Number 3, 2002