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1、复杂腹腔感染浙江省嘉兴市第二医院ICU蔡继明IAI相关指南theTherapeuticAgentsCommitteeoftheSurgicalInfectionSociety,TheSurgicalInfectionSocietyGuidelinesonAntimicrobialTherapyforIntra-AbdominalInfections:AnExecutiveSummary,SURGICALINFECTIONSVolume3,Number3,2002IDSA,theSurgicalIn
2、fectionSociety,theAmericanSocietyforMicrobiology,andtheSocietyofInfectiousDiseasePharmacists,GuidelinesfortheSelectionofAntiinfectiveAgentsforComplicatedIntra-abdominalInfections，CID2003,37:997–1005DiagnosisandManagementofComplicatedIntra-abdominalInf
3、ectioninAdultsandChildren:GuidelinesbytheSurgicalInfectionSocietyandtheInfectiousDiseasesSocietyofAmerica；ClinicalInfectiousDiseases2010;50:133–64InfectiousDiseasesSocietyofTaiwan;TaiwanSurgicalSocietyofGastroenterology,etal,Guidelinesforantimicrobial
4、therapyofintra-abdominalinfectionsinadults,JMicrobiolImmunolInfect.2008;41:279-281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%in1900to23%in2002IAI不同来源感染的死亡率appendix(0.25%)stomach/duodenum(21%)pancreas(33%)smallbowel(38%)largebowel(45%)biliarytract(50%)JOHN
5、A.WEIGELT,MD,Empirictreatmentoptionsinthemanagementofcomplicatedintra-abdominalinfections,clevelandclinicjournalofmedicinevolume74•supplement4august2007IAI定义分类f.M.pieracci,p.S.barie,ManageMentofSevereSepSiSofabdoMinalorigin,ScandinavianJournalofSurger
6、y96:184–196,2007单纯腹腔感染复杂腹腔感染Intra-abdominalinfectionsalsocanbecategorizedasuncomplicatedversuscomplicated,althoughthedistinctionisnotalwaysclearJOHNA.WEIGELT,MD,Empirictreatmentoptionsinthemanagementofcomplicatedintra-abdominalinfectionsCLEVELANDCLINI
7、CJOURNALOFMEDICINEVOLUME74•SUPPLEMENT4AUGUST2007UncomplicatedIAI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BlotS,DeWaeleJJ.Criticalissuesintheclinicalmanagementofcomplicatedintra-abdominalinfections.Drugs.2005;65(12):1611-20复杂腹腔感染(cIAI)复杂腹腔感染(cIAI
8、)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JOHNA.WEIGELT,MD,Empirictreatmentoptionsinthemanagementofcomplicatedintra-abdominalinfectionsCLEVELANDCLINICJOURNALOFMEDICINEVOLUME74•SUPPLEMENT4AUGUST2007B
