Source Control bei abdomineller Infektion

Zusammenfassung

Die Kenntnis der Pathophysiologie bei einer intraabdominellen Infektion ist die Grundlage für die Entwicklung therapeutischer Strategien. Die häufigste Infektion ist die sekundäre Peritonitis. Sie umfasst weitgehend die klassischen chirurgischen Peritonitispatienten. Neben den chirurgischen Maßnahmen mit dem Ziel der Herdsanierung und anschliessender Lavage wird initial mit einer kalkulierten antimikrobiellen Therapie begonnen. Das Zeitintervall zwischen dem Auftreten der ersten Symptome und der Source Control ist prognostisch außerordentlich wichtig. Ziel ist eine einzeitige Operation mit frühzeitiger, definitiver Fokussanierung. Für die Herdsanierung gilt, dass die einfachste und am wenigsten invasive Maßnahme die beste ist. Die Peritoneal-Lavage erfolgt ausgiebig mit physiologischen Lösungen. Zusätze verbessern die Infektkontrolle nicht. Im Gegensatz zur lokalen abdominellen Infektion fordert die abdominelle Sepsis immer multidisziplinäre Therapiekonzepte.

Abstract

Understanding the pathophysiology of intra-abdominal infection is the basis for developing therapeutical strategies. The most frequent intra-abdominal infection is the secondary peritonitis. It encompasses the common forms of surgical peritonitis. Apart from surgical measures to control the source, usually followed up with a lavage, it is common practice to simultaneously start with a calculated antibiotic therapy. Limiting the time span between the first symptoms and the source control, is of utmost importance. The aim is to carry out one single procedure at an early stage. It has been shown that for any sort of source control the most simple and least invasive measure should be preferred. For the lavage, best results have been achieved by using physiological fluids without any additives. Additives didn't improve the infection control. Contrary to the local abdominal infections, abdominal sepsis requires multidisciplinary therapeutical approaches.

Schlüsselwörter

intraabdominelle Infektion - sekundäre Peritonitis - Source Control

Key words

intra-abdominal infection - secondary peritonitis - source control

Literatur

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