Current standards of care in the management of patients with abdominal sepsis
Authors:
P. Ihnát 1,2; M. Peteja 1,2; P. Vávra 1,2; L. Tulinský 1,2; P. Zonča 1,2
Authors‘ workplace:
Katedra chirurgických oborů, LF Ostravské Univerzity, Ostrava, vedoucí katedry: MUDr. P. Vávra, Ph. D.
1; Chirurgická klinika FN Ostrava, přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS
2
Published in:
Rozhl. Chir., 2015, roč. 94, č. 6, s. 234-237.
Category:
Review
Overview
Introduction:
Abdominal sepsis patient management is an issue of high current importance, and the amount of knowledge keeps increasing and changing the approach to critically ill patients with abdominal sepsis.
Methods:
Literature search (in MEDLINE, PubMed and Google Scholar databases) was done, focused on identification of relevant studies. The aim of this paper is to provide a review of current trends in diagnosing and predicting the prognosis of, and recommended treatment standards for patients with abdominal sepsis.
Results:
Abdominal sepsis is defined as the Systemic Inflammatory Response Syndrome (SIRS) with an abdominal infection requiring a surgical intervention to control the source; or SIRS with an infection within 14 days after any major surgery. Although many different monitoring and scoring systems exist, daily careful clinical examination is the most reliable diagnostic tool in identification of septic patients. Whenever abdominal sepsis is suspected, the gold standard comprises immediate administration of broad-spectrum antibiotics, transferring the patient to the intensive care unit, with surgical intervention and supportive intensive care based on current guidelines of the Surviving Sepsis Campaign. Source control surgery is the principal therapeutic modality for patients with abdominal sepsis. The most relevant negative prognostic factors include clinical signs of septic shock and the necessity of high doses of catecholamines.
Conclusion:
Early identification of septic patients and prompt implementation of a complex, evidence-based interdisciplinary approach are the principal conditions for improving healthcare outcomes of care provided to patients with abdominal sepsis.
Key words:
abdominal sepsis – surgical source control – prognosis prediction – intensive care
Sources
1. Moore LJ, Moore FA. Early diagnosis and evidence-based care of surgical sepsis. J Intensive Care Med 2013;28:107−17.
2. Moore LJ, Moore FA, Todd SR, et al. Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective. Arch Surg 2010;145:695−700.
3. Hagel S, Pletz MW, Brunkhorst FM, et al. Bacteremia and sepsis. Internist 2013;54:399−407.
4. Angus D, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840−51.
5. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2012;39:165−228.
6. Welsch T, Frommhold K, Hinz U, et al. Persisting elevation of C-reactive protein after pancreatic resections can indicate developing inflammatory complications. Surgery 2008;143:20−8.
7. Rivers EP, Jaehne AK, Nguyen HB, et al. Early biomarker activity in severe sepsis and septic shock and a contemporary review of immunotherapy trials: not a time to give up, but to give it earlier. Shock 2013;39:127−37.
8. Robson W, Beavis S, Spittle N. An audit of ward nurses knowledge of sepsis. Nurs Crit Care 2007;12:86−92.
9. Poeze M, Ramsay G, Gerlach H, et al. An international sepsis survey: a study of doctors’ knowledge and perception about sepsis. Crit Care 2004;8:R409−R413.
10. Taenzer AH, Pyke JB, McGrath SP, et al. Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology 2010;112:282−7.
11. De Waele JJ. Early source control in sepsis. Langenbecks Arch Surg 2010;395:489−94.
12. Fleig V, Brenck F, Wolff M, et al. Scoring systems in intensive care medicine: principles, models, application and limits. Anaesthesist 2011;60:963−74.
13. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infectious diseases society of America. Clin Infect Dis 2010;50:133−64.
14. Hecker A, Uhle F, Schwander T, et al. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbecks Arch Surg 2014;399:11−22.
15. Schein M, Marshall J. Source control for surgical infections. World J Surg 2004;28:638−45.
16. Fitousis K, Moore LJ, Hall J, et al. Evaluation of empiric antibiotic use in surgical sepsis. Am J Surg 2010;200:776−82.
17. Leibovici L, Shrega I, Drucker M, et al. The benefits of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998;244:379−86.
18. Kumar A, Roberts D, Wood KE, el al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589−96.
19. Levy MM, Dellinger RP, Townsend SR, el al. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 2010;36:222−31.
20. Imirzalioglu C, Hain T, Chkraborty T, et al. Hidden pathogens uncovered: metagenomic analysis of urinary tract infections. Andrologia 2008;40:66−71.
21. Arabestani MR, Fazzeli H, Nasr Esfahani B. Identification of the most common pathogenic bacteria in patietns with suspected sepsis by multiplex PCR. J Infect Dev Ctries 2014;8:461−8.
22. Chang SS, Hsieh WH, Liu TS, el al. Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis – a systemic review and meta-analysis. PLoS One 2013;8:e62323
23. Hanisch E, Brause R, Paetz J, et al. Review of a large clinical series: predicting death for patients with abdominal septic shock. J Intensive Care Med 2011;26:27−33.
24. Lichtenstern C, Brenner T, Bardenheuer HJ, et al. Predictors of survival in sepsis: what is the best inflammatory marker to measure? Curr Opin Infect Dis 2012;25:328−336.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2015 Issue 6
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