Antibiotics and perforation - Forum

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Billroth

Antibiotics and perforation - Ärzteforum

Post#1 »

I had a patient on whom I operated 4 days after a laparoscopic removal of an ovarian cyst. She had been on ampicillin, gentamicin, and clindamycin since the laparoscopy for uncertain reasons.

At operation there was a large abscess in the lower abdomen, and a large perforation of the sigmoid colon. Cultures were taken. I did a Hartmann procedure. A week later I reoperated for multiple abscesses, and left her abdomen open. She had multiple trips to the OR but eventually recovered completely. ALL her cultures grew only Candida Albicans. She was treated initially with fluconazole, but eventually was given a full dose of Amphotericin B. I still scratch my head when I recall that case. I guess the triple antibiotics supressed everything but fungus, which turned out to be more pathogenic than the usual flora. Anyway, the cultures turned out to be useful.

If one were to culture the fluid identified at operation after perforation of a duodenal ulcer, and Candida were to be identified, would anyone treat it?

I certainly understand your rationale, and I don't culture shit from community-acquired peritonitis, sometimes it's worthwhile to obey the dogma and not think so much.


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Surgeon

Re: Antibiotics and perforation - Ärzteforum

Post#2 »

Your comments regarding antibiotics, WBC, etc. are refreshing and the subject a cause for daily battle with our ID gurus. Is there a single review or textbook chapter you can recommend to those of us who are a few years distant from our boards and not due to recertify for another 5 years?

Grandpa Phil

Re: Antibiotics and perforation - Ärzteforum

Post#3 »

The problem perhaps is that your conceps are a little ancient. Thus, the term "abdominal sepsis" is now obsolete- I understand "abdominal infection", "abdominal comtamination" but not "abdominal sepsis". Please also define what is "a sufficient time"- "sufficient" for what and decided by whom?

Try to culture the peritoneum in patinets with perforated duodenal ulcer- see what will you grow? Almost nothing.

I do not want to "block" the members' mail boxes. Should you really desire to educate yourself in modern practice of antibioitc management of surgical infections -which I sincerely doubt- please allow me to e-mail you some educationay material-directly to your private box. I hope, however, that you have enough space on your hard disk.

Pet

Re: Antibiotics and perforation - Ärzteforum

Post#4 »

You are confusing 2 entirely different clinical scenarios.

The first patient had a neglected intra-abdominal infection- initially mistreated with antibiotics. The Candida in such a patient represents superinfection in a compromised host. Anti-fungal therapy was appropriate. prolonged antibiotic therapy is ofcourse a sin qua non for the development of significant fungal infections.

The second case- early operation for peptic perforation is different. Candida- is commonly cultured from such patients' abdomen and the CONSENSUS is that it must NOT be treated. Only French surgeons religiously add routine anti-fungal regimen to their antibiotics in perforated peptic ulcer.

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A Doctor

Re: Antibiotics and perforation - Ärzteforum

Post#5 »

The other clinic in town almost always puts their GI surgical patients on IV Diflucan (fluconazole) prophylactically. Of course, their surgeon takes 3 or 4 times as long as anyone else to do the same procedures so maybe they are at higher risk of Candida. Then again, they use prolonged antibiotic courses so maybe that is why they end up with yeast.

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