PDF(Pubmed)
Abstract：
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
摘要：
腹腔内感染（IAI）是最常见的全球医疗保健挑战之一，通常是由胃肠道（GI）的破坏引起的。他们的成功管理通常需要密集的资源利用，尽管有最好的治疗方法，发病率和死亡率仍然很高。适当治疗与其他脓毒症病因不同的IAI所需的主要问题之一是经常需要提供物理源控制。幸运的是,在这方面的治疗已经取得了巨大的进步。历史上,源代码控制只留给外科医生。采用新技术，引入了非外科手术的微创介入程序。或者，除了正式的手术外,开腹技术长期以来一直被提出作为严重腹内脓毒症的源头控制辅助手段.具有讽刺意味的是，尽管缺乏甚至延迟控制源头显然与死亡有关，这是一个描述不佳的概念。例如,没有明确的定义源控制技术，甚至充分性已被普遍接受。实际上，源代码控制涉及一个复杂的定义，包括几个因素，包括因果事件，感染源细菌，当地细菌菌群，患者状况,和他/她最终的合并症。随着对败血症的全身病理生物学和人类微生物组的深刻理解，充分的源头控制不再只是一个外科问题，而是一个需要多学科的问题，多模态方法。因此，虽然必须控制胃肠道的任何裂口，源头控制还应尝试控制全身生物宿主的产生和传播，以及对微生物组的生态失调影响，从而使多系统器官功能衰竭和死亡长期存在。鉴于这些增加的复杂性，本文代表了世界急诊外科学会的当前意见和未来研究的建议，欧洲外科感染学会和美国外科感染学会全球外科感染联盟关于腹腔内感染源控制的概念和操作充分性。
