LAPAROTOMIE POUR SEPSIS INTRA-ABDOMINAL - Mapar

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674 MAPAR 2000 L’attitude conventionnelle est de prescrire une antibiothérapie à large spectre. Cette attitude est récemment remise en cause au profit d’une antibiothérapie plus ciblée afin d’éviter l’apparition de mutant résistant lors des péritonites tertiaires [50]. 4.3.3. DUREE DU TRAITEMENT La durée de l’antibiothérapie est dictée par l’état clinique du patient. Si l’infection reste localisée, des durées courtes (5 jours voire 48 heures) sont licites. Dans les péritonites secondaires compliquées de choc septique, le traitement doit être poursuivi 7 à 14 jours, jusqu’à l’ablation des drains, une leucocytose < 12 000/mm3 et la normalisation de la température. Ces critères ne sont pas formels. CONCLUSION Le sepsis intra-abdominal est évoqué dès les premiers signes de complications survenant en période postopératoire dans le but de ré-intervenir dans les plus brefs délais. L’objectif principal est d’éviter l’installation d’un tableau de défaillance multiviscérale qui deviendra rapidement incontrôlable. Un faisceau d’argument clinique, bactériologique et radiologique permet de conduire le patient au bloc opératoire où le diagnostic est confirmé ou infirmé. L’antibiothérapie optimale, prescrite selon les antibiotiques précédemment administrés, le résultat des prélèvements bactériologiques et l’écologie du service, n’est qu’un traitement adjuvant à la chirurgie et aux mesures symptomatiques. REFERENCES BIBLIOGRAPHIQUES [1] Weinstein WM, Onderdonk AB, Barlett JG, Gorbach SL. Experimental intraabdominal abscesses in rats. Development of an experimental model. Infect Immun 1974;10:1250-5 [2] Christou NV, Barie PS, Dellinger EP, Waymack JP, Stone HH. Surgical Infection Society Intra-abdominal Infection Study. Prospective evaluation of management techniques and outcome. Arch Surg 1993;218:193-8 [3] Saini S, Kellum JM, O’Leary MP, et al. Improved localization and survival in patients with intraabdominal abscesses. Am J Surg 1983;145:136-42 [4] Chalfine A, Dazza FE, Morin JP, Carlet J. Péritonites communautaires et nosocomiales. In Sfar, éd. Conférences d’actualisation. Congrès national d’anesthésie et de réanimation. Paris:Masson;1994.P.379-91 [5] Troidle L, Gorban-Bremnan N Kliger A, Finkelstein F. Differing outcomes of gram-positive and gramnegative peritonitis. Am J Kidney Dis 1998;32:623-8 [6] Guillou PJ. Biological variation in the developpement of sepsis after surgery or trauma. Lancet 1993;342:217-20 [7] Hammond JM, Potgieter PD. The influence of surgery on cytokines in patients with intra-abdominal sepsis. Anaesth Intensive Care 1996;24:430-4 [8] Holmdahl L, Ivarsson ML. The role of cytokines, coagulation, and fibrinolysis in peritoneal tissue repair. Eur J Surg 1999;165:1012-9 [9] Neumann B, Zantl N, Veihelmann A, et al. Mechanisms of acute inflammatory lung injury induced by abdominal sepsis. Int Immun 1999;11:217-27 [10] Hinsdale JG, Jaffe BM. Re-operation for intra-abdominal sepsis: indications and results in modern critical care setting. Ann Surg 1984;199:31-6 [11] Hollender LF, Meyer C, Phillipides JP, Pierard T, Cordeiro F. Les relaparotomies en chirurgie abdominales. Chirurgie 1982;108:43-51 [12] Bohnen JM, Mustard RA, Oxholm SE, Schouten BD. APACHE II score and abdominal sepsis. A prospective study. Arch Surg 1988;123:225-9
QUOI DE NEUF DANS LE TRAITEMENT DE L’ETAT DE CHOC SEPTIQUE 675 [13] Jiffry BA, Sebastian NW, Amin T, Isbister WH. Multiple laparotomies for severe intra-abdominal infection. Aust N Z J Surg 1998;68:139-42 [14] Bohnen JM, Boulanger M, Meakins JL, McLean APH. Prognosis in generalized peritonitis. Relation to cause and risk factors. Arch Surg 1983;118:285-90 [15] Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg 2000;24:32-7 [16] McLauchlan GJ, Anderson ID, Grant IS, Fearon KCH. Outcome of patients with abdominal sepsis treated in an intensive care unit. Br J Surg 1995;82:524-9 [17] Mäkelä J, Kairaluoma M. Relaparotomy for postoperative intra-abdominal sepsis in jaundiced patients. Br J Surg 1988;75:1157-9 [18] Legall J, Fagniez P, Meakins J, et al. Diagnostic features of early high post-laparotomy fever: a prospective study of 100 patients. Br J Surg 1982;69:452-5 [19] Reith HB, Mittelkotter U, Debus ES, Kussner C, Thiede A. Procalcitonin in early detection of postoperative complications. Dig Surg 1998;15:260-5 [20] Riche F, Panis Y, Laisne MJ, et al. High tumor necrosis factor serum level is associated with increased survival in patients with abdominal septic shock: a prospective study in 59 patients. Surgery 1996;120:801-7 [21] Sinaman M, Maier RN, Carrico J. Laparotomy for intra-abdominal sepsis in intensive care unit. Arch Surg 1984;119:652-8 [22] Weinstein MP, Reller LB. Clinical importance of breakthrough bacteremia. Am J Med 1984;76:175-80 [23] Carlet J, Goldstein FW, Bleriot JP, Bahloul F, Dazza FE. Timentin in the antimicrobial treatment of nosocomial and polymicrobial infections. J Antimicrob Chemother 1986;17:149-59 [24] Montravers P, Gauzit R, Muller C et al. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis 1996;23:486-94 [25] Barkhausen J, Stoblen F, Dominguez-Fernandez E, Henseke P, Muller RD. Impact of CT in patients with sepsis of unknown origin. Acta Radiol 1999;40:552-5 [26] McCrory C, Crowley K. Is repeat laparotomy of value in patients with suspected intra-abdominal sepsis in the intensive care unit? Ir J Med Sci 1997;166:88-91 [27] Cheatham ML. Intra-abdominal hypertension and abdominal compartment syndrome. New Horizons 1999;7:96-115 [28] Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984;199:28-30 [29] Sugerman HJ, Bloomfield GL, Saggi BW. Multisystem organ failure secondary to increased intraabdominal pressure. Infection 1999;27:61-6 [30] Montravers P, Lepers S, Popesco D. Réanimation des sepsis intra-abdominaux après intervention chirurgicale. Presse Med 1999;28:196-202 [31] Halpern NA, McElhinney AJ, Greenstein RJ. Postoperative sepsis: reexplore or observe? Accurate indication from diagnostic abdominal paracentesis. Crit Care Med 1991;19:882-6 [32] Bosscha K, van Vroonhoven Th J M V, van der Werken Ch. Surgical management of severe secondary peritonitis. Br J Surg 1999;86:1371-7 [33] Balague C, Targarona EM, Pujol M, Filella X, Espert JJ, Trias M. Peritoneal response to a septic challenge. Comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall lift laparoscopy. Surg Endosc 1999;8:792-6 [34] Bloechle C, Emmermann A, Strate T, et al. Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs. Surg Endosc 1998;3:212-8 [35] Greif WM, Forse RA. Cardiopulmonary effects of the laparoscopic pneumoperitoneum in a porcine model of adult respiratory distress syndrome. Am J Surg 1999;177:216-21 [36] Orlando R 3 rd , Crowell KL. Laparoscopy in the critical ill. Surg Endosc 1997;11:1072-4 [37] Rosman C, Westerveld GJ, Kool K, Bleichrodt RP. Local treatment of generalised peritonitis in rats; effects on bacteria, endotoxin and mortality. Eur J Surg 1999;165:1072-9 [38] Farthmann EH, Schöffel U. Principles and limitations of operative management of intraabdominal infections. World J Surg 1990;14:210-7 [39] Wittmann DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg 1990;14:218-26
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