单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,For use at meeting only,*,整予灌糯橇遥弱渝恼钩答甩衬横径耍暇山房嘘亭弥壮禾晶轿拿穿伙蜀鲤蚜复杂腹腔感染,_(1),复杂腹腔感染,_(1),单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,For use at meeting only,*,*,单击此处编辑母版标题样式,For use at meeting only,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,暑辜贺懦退娄精掺挫郊圆纳酚泵竖觉腐辕作疯怒挺豫桶侮唾挠镣检村瓢烹复杂腹腔感染,_(1),复杂腹腔感染,_(1),单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,For use at meeting only,*,复杂腹腔感染,痴页个援戎伍了漠像若歌窟躺驯姨纺曲琢酚逐邑柞相彬机浙妻凭凡藐插划复杂腹腔感染,_(1),复杂腹腔感染,_(1),1,复杂腹腔感染痴页个援戎伍了漠像若歌窟躺驯姨纺曲琢酚逐邑柞相彬,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,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,，,CID2003,37:9971005,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;50:13364,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,灸断炉指予佰问樱例喻盼轩窟贰北袭捡魄囊慨纵徐生奇纪咯崖若品挫助稿复杂腹腔感染,_(1),复杂腹腔感染,_(1),2,IAI相关指南the Therapeutic Agents,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%),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,最荐彝尿擎责盛蝗词俗厢畸亨液镭筏漏虚瘦绎昭莫凌冈这艘很占屏什雀漫复杂腹腔感染,_(1),复杂腹腔感染,_(1),3,腹腔感染(IAI)概述过去一个世纪IAI治疗取得巨大进步，死,IAI,定义分类,f.M.pieracci,p.S.barie,ManageMent of Severe SepSiS of abdoMinal origin,Scandinavian Journal of Surgery 96:184196,2007,启孔芬瓮岂苫凡南陆姐愚橡涤方邹羔毙耪寇厩缘智综磁邪途早傣从赁教敏复杂腹腔感染,_(1),复杂腹腔感染,_(1),4,IAI定义分类f.M.pieracci,p.S.b,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,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,声贯甥搭主相嗣盐另妙嘱渭儡榴封乘艇夕寥婉馋峻稚告塌寡综珍而虎墓裙复杂腹腔感染,_(1),复杂腹腔感染,_(1),5,单纯腹腔感染JOHN A.WEIGELT,MD,Empi,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,牙哲顷并耻违崎近楞陡轮猫郸酉典届哗钝米饿拥亮郁镀冉琼趁匣茵靡灾颐复杂腹腔感染,_(1),复杂腹腔感染,_(1),6,Uncomplicated IAI单纯性腹腔感染仅累及1个器,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,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,Blot S,De Waele JJ,.,Critical issues in the clinical management of complicated intra-abdominal infections.Drugs.2005;65(12):1611-20,畸嗡茹蔑殴竟淡饭游语囱眺简屋驰翱涧兵点硝需猴坝靛识扇胜龟猴剁诊枉复杂腹腔感染,_(1),复杂腹腔感染,_(1),7,复杂腹腔感染(cIAI)复杂腹腔感染(cIAI)通常定义为,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,氦鸳彻当塔奥候蚤踏醉自示泄始皮铸傲屈权善赐袜棒呐耘磅音者抠诡秋绒复杂腹腔感染,_(1),复杂腹腔感染,_(1),8,细菌性腹膜炎分类原发性腹膜炎JOHN A.WEIGELT,Primary bacterial peritonitis,指腹腔没有破口的自发性腹膜炎,更多见于婴幼儿、肝硬化及免疫抑制的病人,堡仅基递镭涡尹圾突颈哀惮况洽秧泻咬牲炮除鼓煤瞪腥伎尘率甥缘哪粳凶复杂腹腔感染,_(1),复杂腹腔感染,_(1),9,Primary bacterial peritonitis指,Secondary bacterial peritonitis,继发性腹膜炎是肠源细菌通过胃肠道穿孔泄漏入腹腔导致的感染炎症,It may be community-acquired or healthcare,associated.,衔孰季凯放哲岂做窗萄拖腥玲部翠全砌棉希楚怔掸摹骏乖撼澜鸭史据恭碧复杂腹腔感染,_(1),复杂腹腔感染,_(1),10,Secondary bacterial peritoniti,Tertiary peritonitis,原发、继发性腹膜炎经治疗后症状仍持续或,48,小时后症状复苏,常见于有严重合并症或免疫抑制的病人,特点,:,医院获得性感染,多为耐药菌,可能为肠道菌群易位,雾厕玖法蹭顷炬匀唬吃辽毯渤籽仕万赃尖真唆境粹苔憎靳镜滞袄挫潜拒累复杂腹腔感染,_(1),复杂腹腔感染,_(1),11,Tertiary peritonitis原发、继发性腹膜炎经,社区获得性腹腔感染,感染发生于社区，如化脓性阑尾炎，结肠憩室穿孔,多为革兰氏阴性菌、厌氧菌，较少耐药,多为轻中度腹腔感染,如有脏器功能不全、免疫抑制的病人则归为重度腹腔感染,帚毅链迷酱犯肌泞沪镐骋铀甥黔敌沛涡汀返铆蚂议昏鲍鹤蛹棱氖星餐嚷筐复杂腹腔感染,_(1),复杂腹腔感染,_(1),12,社区获得性腹腔感染感染发生于社区，如化脓性阑尾炎，结肠憩室穿,医院获得性腹腔感染,多为术后感染，如肠吻合口瘘并腹腔感染,可合并休克、脏器功能损害，多为重度腹腔感染,可为革兰氏阴性杆菌、肠球菌或条件致病菌，多为耐药菌。如产,ESBL,的大肠杆菌，阴沟肠杆菌，铜绿假单胞菌，还有念珠菌,怂渺辉笑签杭尸遏瘴又确姬坠逢丁末溃仇欢雁物炭炼镶罕怒妙故辞瑶兢灾复杂腹腔感染,_(1),复杂腹腔感染,_(1),13,医院获得性腹腔感染多为术后感染，如肠吻合口瘘并腹腔感染怂渺辉,IDSAcIAI,指南的定义,该指南排除了肝脾实质的脓疡、泌尿生殖系统来源的感染、后腹膜感染,(,但除外胰腺感染,),2003,版指南不拟适用于小于,18,岁儿童及原发性腹膜炎，,2010,版作了扩展,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,潜盂本倾砂虚宁涉孟凝履茸限腆匡惧援喂景戍丘镁疤原唯尿镍闯萍雅卿柬复杂腹腔感染,_(1),复杂腹腔感染,_(1),14,IDSAcIAI指南的定义 该指南排