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Antibioprophylaxis PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Antibioprophylaxis”.

This medical PowerPoint presentation talks about antibiotic prophylaxis, the use of antibiotics to prevent infections in individuals who are at high risk of developing an infection. Antibiotic prophylaxis is often used in surgical procedures, where there is a risk of infection due to the invasion of bacteria during the surgery. The goal of antibiotic prophylaxis is to reduce the risk of infection and prevent complications.

The choice of antibiotic for prophylaxis depends on the type of surgery and the patients individual risk factors. The duration of prophylaxis is usually limited to the immediate pre-operative period and a few hours post-operatively, to reduce the risk of antibiotic resistance and minimize side effects.

Its important to note that the routine use of antibiotics is not recommended for all surgical procedures, as this can lead to the development of antibiotic-resistant bacteria. Antibiotic prophylaxis should only be used when the benefits outweigh the risks and when there is a high risk of infection.

Tags : Antibioprophylaxis, antibiotic prophylaxis, Gastroenterology, Gastroenterology PowerPoint presentation

Published on : May 02, 2023 | Views : 1405 | Downloads : 0

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Slide 1-

ANTIBIOPROPHYLAXIS Selective gut decontamination One human clinical study Luiten EJT and al Ann Surg 222,57,1995 102 patients with severe AP Oral colistin,amphoB and norfloxacin plus rectal enema Decrease moratlity 35% vs 22% Decrease of laparotomy/pts 0,33 vs 0,08
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INDICATIONS FOR SURGERY IN SEVERE AP Infected necrosis Pancreatic abscess Local complications Massive bleeding Perforation of the bowel Portal vein thrombosis Sterile necrosis with MOF ???
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SURGICAL TECHNIQUES Conventionnal technique Débridement an penrose/sump drainage Highest mortality rate ( around 40% ) More than 35% of the patients need reexploration Low threshold for rexploration is imperative
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SURGICAL TECHNIQUES Open and semi-open technique Laparotomy then packing with gaze Use of syntetic mesh or zipper thereafter As needed bedside rexploration under anesthesia Healing by secondary intention
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SURGICAL TECHNIQUES Open technique=> the zipper suture of a marlex sheet to the abdo. fascia or skin a zipper is sewn in the middle of the marlex daily manual exploration of the abdomen and lavage
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SURGICAL TECHNIQUES
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SURGICAL TECHNIQUES Closed technique Closing of the abdominal wall Intraoperative and postoperative lavage of the lesser sac and the necrosectomy area Continuous lavage by large bore single or double-lumen catheters
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SURGICAL TECHNIQUES BEGER and al Surg Clinics N A,79;4 1999
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BEGER and al Surg Clinics N A,79;4 1999
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Retrospective study of 73 consecutives patients The presence of infected vs non-infected necrosis do not correlate with mortality
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retrospective study No control group for sterile necrosis Surgical indication ? Conclusion of the study is not to the good question
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So it does not answer to the question if the patient has only sterile necrotic pancreatitis and no other surgical indication The better study show that observation is adequate in almost all patient even with MOF Bradley EL 1991 Am J Surg;161:19-24
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NUTRITION Putting the pancreas to rest… traditionnaly NPO and TPN Now four prospective studies with enteral feeding
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NUTRITION Role of the gut in SIRS modulation of inflammatory response bacteria translocation mucosal injury downregulation of the acute phase reaction with enteral feeding
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NUTRITION TEN feasible with jejunostomy on patients requiring laparotomy for AP Kudsk K and al Nutr Clin Pract1990;5:14 Enteral feeding decrease the acute phase response in AP compare to TPN Windsor ACJ and al Gut 1998;42:431-435
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NUTRITION TEN decrease the risk of infection and the total number of complications vs TPN Kalfarentzos F and al Br Jour Surg 1997;84,1665 TEN is well tolerated in almost all patients with severe pancreatitis Eatok F and al Br Jour Surg 1998;85,10
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OCTREOTIDE Recent multicenter RCT on octreotide Uhl W and al Gut 1999,Jul;45(1):97-104 302 pts with severe acute pancreatitis Octreotide vs placebo No difference in death, MODS, complications, LOS and surgery
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OCTREOTIDE Recent review article on octreotide Uhl W and al Digestion 1999;60 Suppl 2:23-31 A lot of controversial studies with a small amount of patients No strong evidence of any benefit as treatment of severe AP
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LEXIPAFANT Systemic complications of acute pancreatitis are associated with pro-inflammatory response cytokines Platelet-activating factor is one of them induced plts aggregation and activation increase vascular permeability activation of monocyte...
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LEXIPAFANT Two human studies Multicenter RCT severe pancreatitis ( 11 cewnters ) Severe pancreatitis Lexipafant vs placebo Result Decrease in MODS and systemic complications Trend in reduce mortality Mckay CJ and al Brit Jour Surg 1997,84,1239-1243 Ongoing multicenter trial
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Conclusion All significant acute pancreatitis should be evaluated with prognosis scale to assess the risk of mortality and morbidity and to determine the patients more likely to benefit from agressive monitoring and treatment either with clinical scale and/or ct-scan
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Conclusion All necrotizing pancreatitis should be considered for an antibioprophylaxis of 14 days with an appropriate antibiotic.
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Conclusion All severe pancreatitis should have a trial of enteral feeding with NJT if there is no contraindications. All acute severe pancreatitis should be considered for a jejunostomy if they have a laparotomy.
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Conclusion Patients with infected necrosis need necrosectomy for most of them by laparotomy. The type of surgical approach thereafter is quite unclear with the actual litterature in the absence of control trial. The main factor is the local surgical expertise.
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Conclusion There is no clear indication for surgery in patient with sterile necrosis.
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Conclusion Patients with severe acute pancreatitis associated with cholestasis,suspected cholangitis or progressive jaundice should be considered for early ERCP to reduce the local complications and the severity of the disease
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Conclusion There is no actual clear role for gabexate,lexipafant and other antiproteinase in the treatment of acute severe pancreatitis otherwise than inside a study protocol
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