İntraabdominal Sepsis

Murat  Aras

doi:10.37609/akya.4154

Yazarlar

Murat Aras

https://orcid.org/0000-0002-4329-4147

DOI: https://doi.org/10.37609/akya.4154.c8268

Özet

Sepsis, enfeksiyona karşı gelişen, konak yanıtında bozulma sonucu organ disfonksiyonu ile seyreden, hızlı ilerleyen ve acil tedavi gerektiren mortal bir klinik tablodur. Güncel yaklaşımlarda sepsis kriterleri benimsenmiş; Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) ve özellikle acil servislerde pratikliği nedeniyle quick SOFA (qSOFA), erken tanıda öne çıkmıştır. İntraabdominal sepsis, sepsisin en sık görülen tiplerinden biri olup abdominal organlar ve periton kaynaklı enfeksiyonlara bağlı gelişir. Çoklu patojen varlığı nedeniyle yönetimi zordur. Risk faktörleri arasında ileri yaş, komorbid hastalıklar, immünsüpresyon ve hastane ilişkili faktörler yer alır. Tanı; klinik bulgular, laboratuvar belirteçleri ve görüntüleme yöntemlerinin birlikte değerlendirilmesini gerektirir. Tedavinin temelini; erken dönemde geniş spektrumlu antibiyotik başlanması, yeterli sıvı resüsitasyonu ve gerektiğinde inotrop tedavisi oluşturur. Erken tanı ve zamanında başlanan etkin tedavi, intraabdominal sepsiste mortaliteyi belirgin şekilde azaltmaktadır.

Sepsis is a life-threatening clinical condition characterized by organ dysfunction resulting from a dysregulated host response to infection, with rapid progression and the need for urgent treatment. Sequential Organ Failure Assessment (SOFA) and particularly due to its practicality in emergency departments, quick SOFA (qSOFA) have gained prominence in early diagnosis. Intraabdominal sepsis isone of the most common types of sepsis and develops due to infections originating in the abdominal organs and peritoneum. It is difficult to manage due to the presence of multiple pathogens. Risk factors include advanced age, comorbid diseases, immunosuppression, and hospital-related factors. Diagnosis requires the combined evaluation of clinical findings, laboratory markers, and imaging modalities. The cornerstone of treatment is early initiation of broad-spectrum antibiotics, adequate fluid resuscitation, and inotropic therapy when needed. Early recognition and timely, effective treatment significantly reduce mortality in intra-abdominal sepsis.

Referanslar

Bone RC, Balk RA, Cerra FB, et al. Definitionsfor sepsis and organ failure and guidelinesfor the use of innovativetherapies in sepsis. Chest. 1992;101(6):1644–1655.doi:10.1007/s11739-021-02735-7.

Guarino M, Perna B, Cesaro AE, et al. 2023 update on sepsis and septicshock in adultpatients: management in the emergencydepartment. Journal of ClinicalMedicine. 2023;12:1–20. doi:10.3390/jcm12000000

Gavelli F, Castello LM, Avanzi GC. Management of sepsis and septicshock in the emergencydepartment. Internal and EmergencyMedicine. 2021;16(6):1649–1661.doi:10.1007/s11739-021-02735-7.

Reinhardt GF, Myscofski JW, Wilkens DB, et al. Incidence and mortality of hypoalbuminemicpatients in hospitalizedveterans. Journal of Parenteral and EnteralNutrition. 1980;4(4):357–359.

Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: internationalguidelinesformanagement of sepsis and septicshock: 2016. IntensiveCareMedicine. 2017;43(3):304–377. doi:10.1007/s00134-017-4683-6.

Singer M, Deutschman CS, Seymour CW, et al. The thirdinternationalconsensusdefinitionsfor sepsis and septicshock (Sepsis-3). Journal of the AmericanMedicalAssociation. 2016;315(8):801–810. doi:10.1001/jama.2016.0287.

Tusgul S, Carron PN, Yersin B, et al. Lowsensitivity of qSOFA, SIRS criteria and sepsis definitiontoidentifyinfectedpatients at risk of complication in the prehospitalsetting and at the emergencydepartmenttriage. ScandinavianJournal of Trauma, Resuscitation and EmergencyMedicine. 2017;25(1):108. doi:10.1186/s13049-017-0449-y.

Park CH, Lee JW, Lee HJ, et al. Clinicaloutcomes and prognosticfactors of patientswith sepsis causedbyintra-abdominalinfection in the intensivecareunit: a post-hoc analysis of a prospectivecohortstudy in Korea. BMC InfectiousDiseases. 2022;22(1):1–11. doi:10.1186/s12879-022-07837-x.

Yan J, Li S, Li S. The role of the liver in sepsis. International Reviews of Immunology. 2014;33(6):498–510. doi:10.3109/08830185.2014.889129.

Montravers P, Blot S, Dimopoulos G, et al. Therapeuticmanagement of peritonitis: a comprehensiveguideforintensivists. IntensiveCareMedicine. 2016;42(8):1234–1247.doi:10.1007/s00134-016-4302-6.

Mendu ML, Zager S, Gibbons FK, et al. Relationshipbetweenneighborhoodpoverty rate and bloodstreaminfections in the criticallyill. Critical CareMedicine. 2012;40(5):1427–1436.doi:10.1097/CCM.0b013e31823c8f4a.

Yalın R. Diagnosis of intra-abdominal sepsis. TurkishJournal of Surgery. 2008;24(3):160–163.

Sartelli M, Chichom-Mefire A, Labricciosa FM, et al. The management of intra-abdominalinfectionsfrom a global perspective: 2017 WSES guidelinesformanagement of intra-abdominalinfections. World Journal of EmergencySurgery. 2017;12(1):29. doi:10.1186/s13017-017-0141-6.

Blot S, Antonelli M, Arvaniti K, et al. Epidemiology of intra-abdominalinfection and sepsis in criticallyillpatients: AbSeS, a multinationalobservationalcohortstudy. IntensiveCareMedicine. 2019;45:1703–1717.doi:10.1007/s00134-019-05819-8.

Faix JD. Biomarkers of sepsis. Critical Reviews in ClinicalLaboratorySciences. 2013;50(1):23–36. doi:10.3109/10408363.2013.764490.

Font MD, Thyagarajan B, Khanna AK. Sepsis and septicshock: basics of diagnosis, pathophysiology and clinicaldecisionmaking. MedicalClinics of North America. 2020;104(4):573–585.doi:10.1016/j.mcna.2020.02.011.

DiSerafino M, Viscardi D, Iacobellis F, et al. Computedtomographyimaging of septicshock. Beyond the cause: the “CT hypoperfusioncomplex”. A pictorialessay. InsightsImaging. 2021;12(1):70. doi:10.1186/s13244-021-01006-5.

Cohen J, Vincent JL, Adhikari NKJ, et al. Sepsis: a roadmapforfutureresearch. The LancetInfectiousDiseases. 2015;15(5):581–614. doi:10.1016/S1473-3099(15)70112-X.

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: internationalguidelinesformanagement of sepsis and septicshock 2021. IntensiveCareMedicine. 2021;47(11):1181–1247.doi:10.1007/s00134-021-06506-y.

Dugar S, Choudhary C, Duggal A. Sepsis and septicshock: guideline-basedmanagement. Cleveland ClinicJournal of Medicine. 2020;87(1):53–64. doi:10.3949/ccjm.87a.18143.

Bakker J, Kattan E, Annane D, et al. Currentpractice and evolvingconcepts in septicshockresuscitation. IntensiveCareMedicine. 2022;48(2):148–163. doi:10.1007/s00134-021-06551-7.

Messmer AS, Zingg C, Müller M, et al. Fluidoverload and mortality in adultcriticalcarepatients: a systematic review and meta-analysis of observationalstudies. Critical CareMedicine. 2020;48(12):1862–1870.doi:10.1097/CCM.0000000000004617.

Permpikul C, Tongyoo S, Viarasilpa T, et al. Earlyuse of norepinephrine in septicshockresuscitation (CENSER): a randomizedtrial. AmericanJournal of Respiratory and Critical CareMedicine. 2019;199(9):1097–1105.doi:10.1164/rccm.201806-1034OC.

Xu F, Zhong R, Shi S, et al. Earlyinitiation of norepinephrine in patientswithsepticshock: a propensityscore-based analysis. AmericanJournal of EmergencyMedicine. 2022;54:287–296. doi:10.1016/j.ajem.2022.01.019.