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Management of infection following intra-abdominal trauma
1Armed Forces Radiobiology Research Institute, National Naval Medical Center, Bethesda, Maryland 20814.
Abstract:
Intra-abdominal infections following abdominal trauma often involve the gastrointestinal aerobic and anaerobic bacterial flora. These organisms possess various virulence factors and exhibit potential synergy between them. The intra-abdominal infection is biphasic, with the Enterobacteriaceae as the major pathogens in the peritonitis stage, and the Bacteroides fragilis group predominant in the abscess stage. Experiments with animals and experience in human beings support the need to use single or combined antimicrobial agent therapy that is effective against both Enterobacteriaceae and the B fragilis group.
Insights
Intra-abdominal infections after trauma involve gut bacteria, with different types dominating early and later stages. Effective treatment requires antibiotics targeting both Enterobacteriaceae and the Bacteroides fragilis group.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Infections
Background:
- Intra-abdominal infections (IAIs) frequently complicate abdominal trauma.
- Gastrointestinal aerobic and anaerobic bacteria are primary causative agents.
- These bacteria possess virulence factors and can act synergistically.
Purpose of the Study:
- To elucidate the microbial dynamics in intra-abdominal infections post-trauma.
- To identify key pathogens during different infection phases.
- To inform optimal antimicrobial therapy strategies.
Main Methods:
- Review of existing literature on IAIs following abdominal trauma.
- Analysis of bacterial flora involved in peritonitis and abscess stages.
- Evaluation of antimicrobial efficacy against key pathogens.
Main Results:
- IAIs exhibit a biphasic pattern.
- Enterobacteriaceae are dominant in the peritonitis stage.
- The Bacteroides fragilis group predominates in the abscess stage.
Conclusions:
- Understanding the biphasic nature of IAIs is crucial for effective management.
- Antimicrobial therapy must address both Enterobacteriaceae and the B fragilis group.
- Combined or single-agent therapy should provide broad coverage.