Wide range

One of the most difficult issues emergency surgery and intensive therapy remains treatment of inflammatory diseases of the abdominal cavity and complications [2]. Dramatically increased the number of patients with infectious forms of pancreatic necrosis, perforation of the gastrointestinal tract, traumatic injuries of the abdomen, peritonitis of different etiology. Lethality is not a clear downward trend and fluctuates according to the last few years, from 19% to 70% [3, 6]. Of course, saving the lives of patients in these cases depends on timely diagnosis and effective surgical intervention. However, any inflammatory and destructive lesions of abdominal organs are inherently abdominal infectious disease, often leading to development of nekurabelnogo sepsis [10]. In this respect, the role of antibiotic therapy is difficult to underestimate [3, 5].

Not replacing, but complementing the surgical treatment, adequate antibiotic treatment can prevent the generalization of infection, the development of postoperative complications and fatal multiple organ failure [10]. Unfortunately, in this respect, the situation is precarious. On the one hand, in the last few years arsenal of antimicrobial agents has increased considerably. There are new high-penicillins, cephalosporins, carbapenems, fluoroquinolones, etc. However, even these antibiotics are not always able to help with untimely and inadequate in their nomination.

Classification of abdominal surgical infections

The term intra-abdominal infections used to refer to a wide range of infectious processes developing under the action of microorganisms colonizing the gastrointestinal tract and penetrate into other normally sterile areas of the abdominal cavity (the exception is the so-called primary peritonitis). From clinical positions, both in terms of surgical approach, and program planning antimicrobial treatment is essential unit of inflammatory processes in the abdominal cavity in uncomplicated and complicated infections.

With uncomplicated infections, no signs of peritonitis and severe systemic inflammatory response. In these cases do not require prolonged some convincing test antimicrobial therapy after surgery, antibiotic treatment is essentially preventive nature.

Complicated infections are characterized by the fact that the infectious process extends beyond the area of its origin, causing peritonitis or abscess formation of the abdominal cavity or retroperitoneum.

Of particular interest are the modern classification of peritonitis as the most frequently recorded forms of complicated intra-abdominal infections.

The etiological classification of peritonitis include primary, secondary and tertiary its shape [6]. Primary peritonitis is a rare form of peritonitis, hematogenous origin of infection of the peritoneum extraperitoneal source. In most cases, primary peritonitis caused hematogenous meningococci, pneumococci, gonococci, staphylococci, enterobacteria and streptococci, are rarely anaerobes. Often, the agent remains unidentified.

Secondary peritonitis is the most common form of complicated intra-abdominal infection and the main reason for abdominal sepsis in surgical patients. In 80% of cases the cause of secondary peritonitis are destructive lesions of the abdominal cavity in 20% of postoperative peritonitis develops after various abdominal surgery.

Tertiary peritonitis or peritonitis manifests without a source brand viagra of infection is a particular problem both in terms of diagnosis and surgical and antibacterial treatment. This recurrent and persistent peritonitis develops in patients in critical states with damage mechanisms of local and systemic anti-infectious protection. Clinical manifestations of such peritonitis erased, characterized by hyperdynamic circulatory disorders, mild hyperthermia, multiple organ dysfunction with no clear local symptoms. At laparotomy causes of peritonitis can not be detected even after repeated surgical interventions. The main reason for this form of peritonitis is an infection with multiresistant strains of coagulase-negative staphylococci, enterococci, Enterobacteriaceae, Pseudomonas, or fungi Candida, which is characteristic of nosocomial infection. Effective antibiotic therapy of tertiary peritonitis is very complicated.

The classification and diagnostic scheme of peritonitis developed in the clinic of Surgery them. SI Spasokukotsky SMU is presented below.

1. Underlying disease (the cause of peritonitis)

2. Etiological characteristics (primary, secondary, tertiary)

3. Prevalence (area of lesion of peritoneum)

4. Characteristics of the exudate

5. Phase flow of the process (no signs of sepsis, sepsis, severe sepsis with multiple organ completely insufficient, an infectious-toxic shock)

6. Complications (intraperitoneal, wound infection, nosocomial pneumonia, angiogenic disease; uroinfektsiya).

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