Abdominal Sepsis: An Update

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Abstract

Despite the significant development and advancement in antibiotic therapy, life-threatening complication of infective diseases cause hundreds of thousands of deaths world. This paper updates some of the issues regarding the etiology and treatment of abdominal sepsis and summaries the latest guidelines as recommended by the Intra-abdominal Infection (IAI) Consensus (2017). Prognostic scores are currently used to assess the course of peritonitis. Irrespective of the initial cause, there are several measures universally accepted as contributing to an improved survival rate, with the early recognition of IAI being the critical matter in this respect. Immediate correction of fluid balance should be undertaken with the use of vasoactive agents being prescribed, if necessary, to augment and assist fluid resuscitation. The WISS study showed that mortality was significantly affected by sepsis irrespective of any medical and surgical measures. A significant issue is the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the clinical setting, and the reported prevalence of ESBLs intra-abdominal infections has steadily increased in Asia. Europe, Latin America, Middle East, North America, and South Pacific. Abdominal cavity pathology is second only to sepsis occurring in a pulmonary site. Following IAI (2017) guidelines, antibiotic therapy should be initiated as soon as possible after a diagnosis has been verified.

1. Alexandraki I, Palacio C. Gram-negative versus Gram-positive bacteremia: what is more alarming? Crit Care. 2010;14:161.

2. Barkhausen T, Tschernig T, Rosenstiel P, et al. Selective blockade of interleukin-6 trans-signalling improves survival in a murine polymicrobial sepsis model. Crit Care Med. 2011;39(6):1407-13.

3. Baron RM, Baron MJ, Perrella MA. Pathobiology of sepsis: are we still asking the same questions? Am J Respir Cell Mol Biol. 2006;34:129–34.

4. Georgescu AM, Szederjesi J, Voidazan S, et al. Soluble urokinase-type plasminogen activator receptor (suPAR) – a possible biomarker for bacteremia in sepsis. Rev Romana Med Lab. 2015;23(1):59-73.

5. Fodor RŞ, Georgescu AM, Cioc AD et al. Time- and dose-dependent severity of lung injury in a rat model of sepsis. Rom J Morphol Embryol. 2015;56(4):1329-37.

6. Marginean CO, Melit LE, Chincesan M, et al. Communication skills in pediatrics – the relationship between pediatrician and child. Medicine. 2017;96(43):e8399.

7. Sartelli M, Chichom-Mefire A, Labricciosa FM. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intraabdominal infections. World J Emerg Surg. 2017;12:1-34

8. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.

9. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010;5:9.

10. Bouali K, Magotteaux P, Jadot A, et al. Percutaneous catheter drainage of abdominal abscess after abdominal surgery: results in 121 cases. J Belg Radiol. 1993;76:11–4.

11. VanSonnenberg E, Mueller PR, Ferrucci Jr JT. Percutaneous drainage of 250 abdominal abscesses and fluid collections. I. Results, failures and complications. Radiology. 1984;151:337–41.

12. Jaffe TA, Nelson RC, DeLong D, Paulson EK. Practice patterns in percutaneous image-guided intra-abdominal abscess drainage: survey of academic and private practice centres. Radiology. 2004;233:750–6.

13. Agresta F, Ciardo LF, Mazzarolo G, et al. Peritonitis: laparoscopic approach. World J Emerg Surg. 2006;24:1–9.

14. Bedada AG, Hsiao M, Bakanisi B, Motsumi M, Azzie G. Establishing a contextually appropriate laparoscopic program in resource-restricted environments: experience in Botswana.

15. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg. 2010;5:9.

16. Montravers P, Dufour G, Guglielminotti J, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:7.

17. Lamme B, Mahler CW, van Ruler O, Gouma DJ, Reitsma JB, Boermeester MA. Clinical predictors of ongoing infection in secondary peritonitis: a systematic review. World J Surg. 2006;30:2170–81.

18. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369:1726–34.

19. Sartelli M, Abu-Zidan FM, Catena F, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intraabdominal infections: a prospective multicenter study (WISS Study). World J Emerg Surg. 2015;10:61

20. Calandra T, Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33(7):1538–48.

21. Hawser SP, Bouchillon SK, Hoban DJ, Badal RE. In vitro susceptibilities of aerobic and facultatively anaerobic gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study. Int J Antimicrob Agents. 2009;34:585–8.

22. Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel). 2013;6:1335–46.

23. Sartelli M, Weber DG, Ruppé E, et al. Antimicrobials: a global alliance for optimizing their rational use in intraabdominal infections (AGORA). World J Emerg Surg. 2016;11:33.

24. Kong VY, Sartorius B, Clarke DL. Acute appendicitis in the developing world is a morbid disease. Ann R Coll Surg Engl. 2015;97:390–5.

25. Andersen JC, Bundgaard L, Elbrønd H, Laurberg S, Walker LR, Støvring J. Danish national guidelines for treatment of diverticular disease. Dan Med J. 2012;59: C4453.

26. Cirocchi R, Trastulli S, Desiderio J, et al. Treatment of Hinchey stage III-IV diverticulitis: a systematic review and meta-analysis. Int J Colorectal Dis. 2013;28:447–57.

27. Meyer F, Marusch F, Koch A, et al. Emergency operation in carcinomas of the left colon: the value of Hartmann’s procedure. Tech Coloproctol. 2004;8 Suppl 1:s226–9.

28. Shin DK, Shin SY, Park CY, et al. Optimal methods for the management of iatrogenic colonoscopic perforation. Clin Endosc. 2016;49:282–8.

29. An SB, Shin DW, Kim JY, Park SG, Lee BH, Kim JW. Decision-making in the management of colonoscopic perforation: a multicentre retrospective study. Surg Endosc. 2016;30:2914–21.

30. Søreide K, Thorsen K, Søreide JA. Predicting outcomes in patients with perforated gastroduodenal ulcers: artificial neural network modelling indicates a highly complex disease. Eur J Trauma Emerg Surg. 2015;41:91–8.

31. Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev. 2013;2:CD004778.

32. Ayite A, Dosseh DE, Tekou HA, James K. Surgical treatment of single non-traumatic perforation of the small bowel: excision-suture or resection anastomosis. Ann Chir. 2005;131:91–5.

33. Ara C, Sogutlu G, Yildiz R, et al. Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure. J Gastrointest Surg. 2005;9:514–7.

34. Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25.

35. Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6:533–41,

36. Bin OY, Zeng KW, Hua HW, Zhang XQ, Chen FL. Endoscopic nasobiliary drainage and percutaneous transhepatic biliary drainage for the treatment of acute obstructive suppurative cholangitis: a retrospective study of 37 cases. Hepatogastroenterology. 2012;59:2454–6.

37. Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol. 2013;9:2293–7.

38. Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27:793–809.

39. Garbin O, Verdon R, Fauconnier A. Treatment of the tubo-ovarian abscesses. J Gynecol Obstet Biol Reprod. 2012;41:875–85.

40. Weinberg JA, Griffin RL, Vandromme MJ, et al. Management of colon wounds in the setting of damage control laparotomy: a cautionary tale. J Trauma. 2009;67:929–35.

41. Miller PR, Chang MC, Hoth JJ, Holmes JH, Meredith JW. Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe? Am Surg. 2007;73:606–9.

42. Mureşan M, Bancu S, Bara T, Bancu L, Turcu M, Mureşan S. Local recurrence after the sphincter –saving operation and abdominal perineal resection in rectal cancer. Chirurgia. 2009;104(4):23-25.

43. Duggan S, Leonhardt I, Hünniger K, Kurzai O. Host response to Candida albicans bloodstream infection and sepsis. Virulence. 2015;6(4):316-26.

44. Auma MA, Siedner MJ, Nyehangane D, et al. Malaria is an uncommon cause of adult sepsis in south-western Uganda. Malaria Journal. 2013;12:146.

45. Stearns-Kurosawa DJ1, Osuchowski MF, Valentine C, Kurosawa S, Remick DG. The pathogenesis of sepsis. Annu Rev Pathol. 2011;6:19-48.

46. Remick DG. Pathophysiology of sepsis. Am J Pathol. 2007; 170:1435–44.

47. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.

48. Muresan M, Muresan S, Bara T, et al. The intraabdominal pressure: A real indicator of the tension-free principle during anterior wall repair procedure after incisional hernias. Ann Ital Chir. 2015;86(5):421-26.

49. Muresan M, Muresan S, Brinzaniuc K, et al. How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome? A single-centre prospective study on 66 patients. Medicine. 2017; 96(5):e6006.

50. Oberhoffer M, Karzai W, Meier-Hellmann A, Bogel D, Fassbinder J, Reinhart K. Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis. Crit Care Med. 1999;27:1814–8.

51. Rose-John S, Scheller J, Elson G, Jones SA. Interleukin-6 biology is coordinated by membrane-bound and soluble receptors: role in inflammation and cancer. J Leukoc Biol. 2006;80:227–36.

52. Mima T, Nishimoto N. Clinical value of blocking IL-6 receptor. Curr Opin Rheumatol. 2009;21(3):224-30

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