cefotaxime and Abdominal-Abscess

Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs.. To compare 2 groups of similar patients, to determine whether administration of antibiotics, started during surgery, is actually useful in reducing the risk of residual abscess or infection in the surgical wound.. The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy. This total was divided at random into 2 groups: group A (80 patients) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture, followed by 2 more doses at intervals of 8 hours in the immediate postoperative period; and group B (86 patients) who did not receive any antibiotic treatment at all. The dependent variables observed were surgical wound infection and residual abscess: and the control variables were age, sex, length of operation time, intercurrent illnesses, and American Society of Anesthesiologists (ASA) classification.. Two patients (2.5%) in group A developed a surgical wound infection, against 3 cases (3.4%) in group B, the result having no statistical significance. No patients developed residual abscess. In a multivariant analysis, the following were identified as independent factors significantly associated with the onset of surgical wound infection (P<0.001): diabetes mellitus, being over 60 years of age, operation time lasting longer than 70 minutes, and ASA 3.. Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60, or who have an ASA classification of 3 or more, or if the operation itself is likely to last more than 70 minutes, the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery.

Topics: Abdominal Abscess; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefotaxime; Cholecystectomy, Laparoscopic; Drug Administration Schedule; Female; Gallbladder; Humans; Intraoperative Care; Intraoperative Complications; Male; Middle Aged; Postoperative Care; Prospective Studies; Rupture; Surgical Wound Infection; Treatment Outcome; Young Adult

The efficacy of piperacillin/tazobactam at 100/12.5 mg/kg every 8 h (35 patients) was compared to cefotaxime plus metronidazole at 50/7.5 mg/kg every 8 h (35 patients) in 70 children with intra-abdominal infections requiring surgery. Diagnoses were gangrenous or perforated appendicitis (n =56), peritonitis (n =12), and abscess (n =2). Clinical cure was observed in 35 of 35 evaluable patients treated with piperacilin/tazobactam and in 34 of 34 evaluable patients treated with cefotaxime plus metronidazole. Presumed bacteriological eradication was noted in 29 of 30 evaluable patients in the piperacillin/tazobactam group and in 31 of 31 evaluable patients in the cefotaxime plus metronidazole group. In this study, piperacillin/tazobactam was as effective as cefotaxime plus metronidazole for treating children with intra-abdominal infections requiring surgery.

Topics: Abdominal Abscess; Adolescent; Appendicitis; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Penicillanic Acid; Peritonitis; Piperacillin; Prospective Studies; Tazobactam; Treatment Outcome

The empiric antibiotic treatment of intraabdominal infections is in constant evolution. Monotherapy appears to be a desirable goal because of the simplicity of its administration, lack of toxic effects and wide spectrum.. A multicentre, prospective, randomized, open study was carried out to compare two antibiotic regimens in the treatment of intraabdominal infections in patients undergoing surgery. Ninety-eight consecutive patients were randomly allocated into two groups. One group (GM, n = 51) received meropenem (1 g/8 h) and the other (GCM, n = 47) a combination of cefotaxime (2 g/8 h) plus metronidazol (0.5 g/8 h). Clinical and bacteriological responses were assessed at the end of treatment and at 2-4 weeks.. The severity of patients as assessed by the APACHE II score was similar in both groups (GM: 7.2 and GCM: 8.1). Three patients in each group could not be evaluated due to premature interruption of treatment or deviation from the protocol. The mean duration of treatment was 7.4 days in GM and 7.9 days in GCM. A satisfactory clinical response was obtained in 95% of patients in both groups. 31 patients (61%) in GM and 26 patients (55%) in GCM were bacteriologically evaluable. Bacteriological erradication was achieved in 94% of patients in GM and in 92% of patients in GCM.. Meropenem is a good alternative for single antibiotic therapy in intraabdominal infections of moderate severity.

Topics: Abdomen; Abdominal Abscess; Adult; Aged; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Humans; Male; Meropenem; Metronidazole; Middle Aged; Peritonitis; Prospective Studies; Thienamycins

Data on the microbiological epidemiology of Intra-Abdominal Abscesses (IAAs) are very scarce. We aimed to study the microbiological epidemiology of these infections in order to optimize empirical antibiotic therapy.. Between January 2015 and December 2020, we retrospectively analyzed all IAAs files in our hospital. Clinical and microbiological data such as antibiotic susceptibilities were collected.. We studied 243 IAA cases. All in all, 139 (57.2%) IAAs were healthcare-associated and 201 (82.7%) were drained. The highest risk situations for IAAs were appendicitis (n = 69) and diverticulitis (n = 37). Out of the 163 microbiologically documented infections, 136 (81.9%) were polymicrobial. Enterobacterales (n = 192, 36.1%), Enterococcus sp. (n = 84, 17.6%) and anaerobes (n = 66, 16.1%) were the most frequently identified bacteria. Gram-negative bacteria were susceptible to amoxicillin-acid clavulanic, piperacillin-tazobactam, cefotaxime, meropenem in 55.2%, 84.9%, 77.6% and 99.5% of cases, respectively. Concerning Gram-positive bacteria, the susceptibility rate was 81.8% for amoxicillin-clavulanic acid, piperacillin-tazobactam and meropenem, and decreased to 63.4% for cefotaxime.. This study highlights the polymicrobial profile of IAAs and their low susceptibility to amoxicillin and clavulanic acid. The piperacillin-tazobactam association remained the most appropriate empirical antibiotic therapy.

Topics: Abdominal Abscess; Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Humans; Meropenem; Piperacillin, Tazobactam Drug Combination; Retrospective Studies

To describe the clinical presentation and medical management of a cat with perinephric abscessation and urosepsis following urethral obstruction and catheterization.. A 2-year-old intact male domestic shorthaired cat presented to an emergency and referral center for lethargy, vomiting, and hematuria. Severe azotemia and hyperkalemia were observed on a serum biochemistry panel. The patient was diagnosed with urethral obstruction and was treated with urethral catheterization, calcium gluconate, IV fluid therapy, buprenorphine, and prazosin. The patient's azotemia improved, and the hyperkalemia resolved. Urinary catheterization was discontinued. The patient developed pyrexia, worsening azotemia, hypoalbuminemia, hyperbilirubinemia, and dysuria. Urethral catheterization was repeated. Abdominal radiographs showed left renomegaly, and abdominal ultrasound revealed left perinephric fluid. Ultrasound-guided centesis of the perinephric fluid revealed septic inflammation, and the sample was consistent with urine based upon sample creatinine. Fluid from the perinephric abscess and urine from the bladder both grew Pasturella spp. The patient was treated with perinephric catheterization, saline lavage, and a continuous infusion of cefotaxime for 72 h. The patient's azotemia quickly resolved, and the patient was discharged after 6 days of hospitalization. The patient was reported to have made a full recovery.. This is the first described case of perinephric abscess and urosepsis following urethral obstruction in a cat and its successful medical management. Perinephric abscess not associated with intrarenal abscess has not previously been identified. Additionally, continuous antimicrobial infusion to treat overwhelming infection and the use of the RapidBac Vet immunoassay for point-of-care detection of urinary tract infection has not been described in cats.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Cefotaxime; Fluid Therapy; Hyperkalemia; Kidney Diseases; Male; Sepsis; Ultrasonography; Urethral Obstruction; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

Topics: Abdominal Abscess; Adult; Anti-Bacterial Agents; Cefotaxime; Humans; Male; Pelvis; Pneumococcal Infections; Pristinamycin; Retroperitoneal Space; Rifampin; Streptococcus pneumoniae; Young Adult

Controversy persists concerning the management of post-appendectomy intra-abdominal abscesses. We hypothesised that most of these abscesses can be successfully managed by antibiotic treatment alone, avoiding the complications of surgical treatment.. Hospital records of children treated in our unit for intra-abdominal post-appendectomy abscesses over a 6-year period were reviewed retrospectively.. This study investigates a series of 26 children from 2 to 15 years of age presenting with one or more post-appendectomy intra-abdominal abscesses. After an average delay of 7 days after initial surgery, 23 children had developed an isolated abscess, while 3 children had multiple abscesses. Twenty-two patients (84.8 %) were treated conservatively by intravenous triple antibiotic therapy alone. Complete clinical, radiological and biological resolution of the abscesses was obtained in all of these children after a mean hospitalisation of 8 days. Four children (15.2 %) were treated surgically: three children with a stable patient status and one child with septic shock requiring urgent surgery.. The results suggest that intravenous triple antibiotic therapy alone is an efficacious first-line treatment in children developing intra-abdominal abscesses following appendectomy. Surgical intervention is rarely necessary except in patients with an alarming patient status or with signs of septic shock.

Topics: Abdominal Abscess; Adolescent; Anti-Bacterial Agents; Appendectomy; Cefotaxime; Child; Child, Preschool; Clinical Protocols; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Metronidazole; Postoperative Complications; Retrospective Studies; Ultrasonography