Canadian practice guidelines for surgical intra-abdominal infections
Canadian practice guidelines for surgical intra-abdominal infections
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DOI：
10.1155/2010/580340
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发表时间：
2010-03-01
影响因子：
2.8
通讯作者：
Zhanel, George G.
中科院分区：
文献类型：
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作者：
Chow, Anthony W.;Evans, Gerald A.;Zhanel, George G.
复杂性腹内感染(IAIs)仍然是临床实践中的一大挑战。除了患者的显著发病率和死亡率外，它们还消耗了大量的医院资源。潜在的抗菌剂滥用可能导致次优治疗，并鼓励在卫生保健环境中选择和传播具有抗生素耐药性的微生物，这加剧了这一问题。本指南由加拿大外科学会(CSS)和加拿大医学微生物学和传染病协会(AMMI)联合制定。主要任务是自2003年美国传染病学会(IDSA)发布《抗微生物治疗指南》以来，为复杂的IAIS的医疗和外科管理提供最新建议(1)。特别关注的是基于流行病学研究的不良结局的风险分层，肠道病原菌的抗菌药敏感性和耐药性的现状，基于随机临床试验的抗菌药方案的治疗效果，手术和经皮来源控制方法，腹内高压(IAH)和腹腔室综合征(ACS)在IAI中的作用，以及术后IAI和手术部位感染的感染控制和预防措施。另一个目标是使用标准化分级系统，根据现有证据的强度和质量对建议进行分类。重要的是，目前的指南根据临床环境和加拿大医疗保健系统特有的问题，为复杂的IAIS的初步经验性抗菌治疗提供了建议。下面总结了根据指南中更详细讨论的主要部分分组的关键循证建议。每项建议都根据指南工作组评估的支持强度(A至C类)和证据质量(I至3级)进行评级。
Complicated intra-abdominal infections (IAIs) remain a major challenge in clinical practice. In addition to significant morbidity and mortality for patients, they consume substantial hospital resources. This is Compounded by the potential Misuse of antimicrobial agents that may result in suboptimal treatment, as well as encourage the selection and spread of antibiotic-resistant microorganisms in the health care setting. The present guideline was developed jointly by the Canadian Surgical Society (CSS) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada. The primary goat was to provide updated recommendations for the medical and Surgical management of complicated IAIs since publication of the 2003 antimicrobial treatment guideline by the Infectious Diseases Society of America (IDSA) (1). Particular focus is directed at risk stratification for poor Outcome based on epidemiological Studies, current status of antimicrobial susceptibility and resistance profiles among enteric pathogens, therapeutic efficacy of antimicrobial regimens based on randomized clinical trials, operative versus percutaneous approaches for Source control, the role of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in IAI, and infection control and preventive measures for postoperative IAIs and Surgical site infections. An additional objective is to categorize the recommendations according to the strength and quality of the available evidence using a standardized grading system. Importantly, the current guideline provides recommendations for initial empirical antimicrobial management of complicated IAIs based on clinical settings and issues unique to the Canadian health care system.Summarized below are the key evidence-based recommendations grouped according to the main sections discussed in more detail in the guideline. Each recommendation is rated by the strength Of Support (category A to C) and quality of evidence (grade I to 3) as assessed by the working group of the guideline.