Analysis of surgical treatment and outcomes of complicated intraabdominal infections

Yıl 2018, , 791 - 807, 15.08.2018

Sabri Özdaş Safa Önel Mehmet Şirik

https://doi.org/10.30569/adiyamansaglik.415553

Öz

Aim: Despite recent advances in treatment, the mortality rate due to
complicated intra-abdominal infection (cIAI) still remains high We aimed to
present the clinical characteristics and outcome of patients with cIAI who were
treated surgically.

Methods: Seventy-two patients (28 female, 44 male; mean age 44.2 years) who were
diagnosed with cIAI and underwent surgical treatment between May 2012 and May
2013 included in this study. The clinical characteristics of patients, origin
of infection, microbiology of peritoneal fluid, and outcome of surgery were
also recorded.

Results: Sixty-one patients (84.7%) acquired cIAI from community, whereas 11
patients (15.3%) from nosocomial sources. Twenty-four patients (33.3%) had
disseminated peritonitis, and the remaining 48 patients (66.6%) had local
peritoneal infection or abscesses. Infected fluid from peritoneal cavity was positive
for E. coli in 27 patients (38%), and
for B. fragilis in 17 patients (24%).
Fourteen patients (19.4%) were followed up in the intensive care unit. Overall
postoperative mortality rate was 8.3% (6 patients).

Conclusion: The cIAI is an emergency
medical condition with high mortality rate. In addition to early diagnosis and
preventive measures, advanced surgical techniques and postoperative care are
critical to obtain better outcomes.

Anahtar Kelimeler

Complicated intra-abdominal infection, Peritonitis, Antibiotic therapy

Komplike İntraabdominal Enfeksiyonların Cerrahi Tedavi ve Sonuçlarının Analizi

Öz

Amaç: Bu çalışmamızda kliniğimize akut karın bulguları ile gelen ve opere edilen komplike karın içi enfeksiyonlu hastaların pre-postop
takip ve tedavilerinin mortalite ve morbiditelerini izlemsel olarak ortaya
koyulmasını amaçladık.

Yöntemler: Çalışmamız kliniğimizde Mayıs 2012 ile Mayıs 2013 tarihleri arasında
opere komplike karın içi enfeksiyonlu hastaların verilerini içermektedir. Bu
veriler şunlardır: (i) hasta ve hastalık özellikleri, yani, demografik veriler,
enfeksiyon tipi, şiddet kriteri, ameliyat öncesinde 7 gün uygulanan küratif
antibiyotik tedavisi; (ii) enfeksiyon kökeni ve uygulanan cerrahi işlemler
(iii) mikrobiyolojik veriler ve bakteriyel izolatların antibiyotik
duyarlılıklarıdır. Hastaların hastanede toplam kalış süreleri, post-op yoğun
bakımda takip edilen hasta sayısı dikkate ve bu verilerin istatiksel analizleri
anlatılmıştır.

Bulgular: Çalışmaya 28( % 38,8)’i kadın, 44( % 61,2 )’ü erkek olmak üzere 72
hasta dahil edildi. Hastaların radyolojik olarak ADBG, USG ve karın CT ile
teyit edilmiş, klinik tam parametreleri ortaya konulmuş ve gelen hastaların %
100’de Karın ağrısı ve karında hassasiyet ön planda olmuştur. Aynı zamanda risk
faktörleri skalası ortaya konulmuştur. 24(% 33,3) hastada yaygın periton
enfeksiyonu gözlemlenirken 48(% 66,6) hastada lokal periton enfeksiyonu yada
apseler bildirilmiştir. 72(% 100) hastadan kültür amaçlı batın içi enfekte sıvı
alındı. 14 hasta (% 19,4) durumu kritik olarak kabul edildi ve yoğun bakım
ünitesinde takip edildi. Hastaların 66(% 91,6) ilk geliş beyaz küreleri
yüksekti, 4(% 5,5) hastada aldıkları kemoterapi nedeniyle beyaz küre’leri
normalin altındaydı.

Sonuç: Komplike İntraabdominal Enfeksiyonlar mortalite oranının yüksek olduğu
acil bir tıbbi durumdur. Erken tanı ve önleyici tedbirlerin yanı sıra, ileri
cerrahi teknikler ve postoperatif bakım daha iyi sonuçların elde edilmesi için
kritik öneme sahiptir.

Anahtar Kelimeler

Komplike karın içi enfeksiyon, Peritonit, Antibiyotik tedavisi

Kaynakça

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