Therapeutic management of peritonitis: a comprehensive guide for intensivists

Montravers, Philippe; Blot, Stijn; Dimοpoulos, George; Eckmann, Christian; Eggimann, Philippe; Guirao, Xavier; Paiva, José Artur; Sganga, Gabriele; Waele, Jan J. De

doi:10.1007/s00134-016-4307-6

Cited by 72 publications

(57 citation statements)

References 67 publications

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“…In patients with sepsis or septic shock, antibiotics should be delivered within one hour. The selection of antimicrobial agent and recent national and international guidelines on antibiotic selection have been reviewed recently 130. The decision to cover drug resistant organisms or to add empiric fungal coverage should be based on individual risk factors 130.…”

Section: Managementmentioning

confidence: 99%

“…The selection of antimicrobial agent and recent national and international guidelines on antibiotic selection have been reviewed recently 130. The decision to cover drug resistant organisms or to add empiric fungal coverage should be based on individual risk factors 130. Patients with a history of solid organ transplant, with underlying pulmonary or liver disease, or with a duodenal source of peritonitis and postoperative patients with exposure to broad spectrum antibiotics within three months or preoperative hospital admission for longer than five days are all at increased risk of drug resistant organisms 131132133.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Secondary peritonitis: principles of diagnosis and intervention

Ross

Matthay

Harris

2018

BMJ

108

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Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Secondary peritonitis: principles of diagnosis and intervention

Ross

Matthay

Harris

2018

BMJ

108

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“…A detailed and much larger analysis of fungal IAI is warranted, with controlled analyses of independent predictors and outcomes. Such investigation could guide the appropriate empiric management of fungal IAI, stratified by the exact clinical syndrome and/or scenario, since the epidemiology of fungal IAI evolved considerably in the past years [17, 25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal Infections: The Role of Anaerobes, Enterococci, Fungi, and Multidrug-Resistant Organisms

Marcus¹,

Lévy

Salhab³

et al. 2016

Open Forum Infectious Diseases

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Background.Intra-abdominal infections (IAI) constitute a common reason for hospitalization. However, there is lack of standardization in empiric management of (1) anaerobes, (2) enterococci, (3) fungi, and (4) multidrug-resistant organisms (MDRO). The recommendation is to institute empiric coverage for some of these organisms in “high-risk community-acquired” or in “healthcare-associated” infections (HCAI), but exact definitions are not provided.Methods.Epidemiological study of IAI was conducted at Assaf Harofeh Medical Center (May–November 2013). Logistic and Cox regressions were used to analyze predictors and outcomes of IAI, respectively. The performances of established HCAI definitions to predict MDRO-IAI upon admission were calculated by receiver operating characteristic (ROC) curve analyses.Results.After reviewing 8219 discharge notes, 253 consecutive patients were enrolled (43 [17%] children). There were 116 patients with appendicitis, 93 biliary infections, and 17 with diverticulitis. Cultures were obtained from 88 patients (35%), and 44 of them (50%) yielded a microbiologically confirmed IAI: 9% fungal, 11% enterococcal, 25% anaerobic, and 34% MDRO. Eighty percent of MDRO-IAIs were present upon admission, but the area under the ROC curve of predicting MDRO-IAI upon admission by the commonly used HCAI definitions were low (0.73 and 0.69). Independent predictors for MDRO-IAI were advanced age and active malignancy.Conclusions.Multidrug-resistant organism-IAIs are common, and empiric broad-spectrum coverage is important among elderly patients with active malignancy, even if the infection onset was outside the hospital setting, regardless of current HCAI definitions. Outcomes analyses suggest that empiric regimens should routinely contain antianaerobes (except for biliary IAI); however, empiric antienterococcal or antifungals regimens are seldom needed.

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“…The quality of source control is difficult to evaluate (24,25) IAIs without it, mortality probably could reach up to 100% (26). The appropriate interventions to determine the adequacy of source control are dictated by the clinical circumstances.…”

Section: Iaismentioning

confidence: 99%

“…Ann Transl Med 2016;4 (17):330 atm.amegroups.com inaccessible abdomen (26). Surgery gives opportunity to take first local microbiological samples however some interventions may cause further complications and risk factors associated with the procedures.…”

Section: Iaismentioning

confidence: 99%