INTRAABDOMINAL INFECTIONS
Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.
SIGN AND SYMPTOMS
Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic encephalopathy could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.
MORTALITY / MORBIDITY
The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.
DIAGNOSIS
The diagnosis of Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from the cavity of abdomen . If the fluid contains bacteria or a big amount of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.
TREATMENT
Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.
PREVENTION
Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time.
SECONDARY PERITONITIS
Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.
CLINICAL FEATURES
Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .
DIAGNOSIS AND TREATMENT
Studies marked leukocytosis with a left shift to find the source of peritonitis are the main treatment. Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.
PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS
Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter removal scheme should be considered if the patient does not improve within 48 hours ....... read more
PRIMARY ( SPONTANEOUS ) BACTERIAL PERITONITIS ( PBP )
Spontaneous bacterial peritonitis (SBP) is to develop peritonitis (infection of the abdominal cavity), although there is no obvious source of infection.It occurs almost exclusively in cases of portal hypertension of people (more of Increased portal vein pressure ), usually a result of cirrhosis of the liver and liver.It may also occur in nephrotic syndrome patients.
Primary bacterial peritonitis is seen as the result of a combination of factors associated with cirrhosis and ascites, and prolonged bacteremia secondary to compromised host defenses, maneuvers intrahepatic blood colonized, and the defective bactericidal activity in the ascites fluid. Contrary to previous theories, transmucosal migration of bacteria in the intestine of ascites is no longer considered to play an important role in the etiology of SBP. With regard to the compromised host defenses, patients with chronic liver disease often have severe acute deficiency of the complement and possibly a system malfunction of neutrophils and the reticuloendothelial system.
ETIOLOGIES
Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.
SIGN AND SYMPTOMS
Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic encephalopathy could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.
MORTALITY / MORBIDITY
The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.
DIAGNOSIS
The diagnosis of Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from the cavity of abdomen . If the fluid contains bacteria or a big amount of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.
TREATMENT
Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.
PREVENTION
Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time.
SECONDARY PERITONITIS
Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.
CLINICAL FEATURES
Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .
DIAGNOSIS AND TREATMENT
Studies marked leukocytosis with a left shift to find the source of peritonitis are the main treatment. Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.
PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS
Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter removal scheme should be considered if the patient does not improve within 48 hours ....... read more
Another interesting post.
ReplyDelete