Antibiotische Behandlung der sekund�ren Peritonitis in Deutschland

Mittelkötter, U.; Endter, F.; Reith, H. B.; Thielemann, Henryk; Schmitz, R.; Ihle, Peter; Kullmann, K.H.

doi:10.1007/s00104-003-0721-8

Cited by 2 publications

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References 7 publications

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“…The choice of antibiotics seem to rely to a large extend on the fact that E. coli has been identified as the most frequent causative agent [ 8 , 40 ]. Its sensitivity pattern validates our choice of antibiotics combination which elements are very widely used [ 40 , 41 ], although some studies have reported other germs with a different sensitivity pattern [ 42 ]. The replacement of 3 rd generation cephalosporin by ampicillin in the protocol has been proved to be a valid cost-effective regimen, especially if combined with gentamicin [ 43 ].…”

Section: Discussionmentioning

confidence: 79%

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

2016

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BackgroundAcute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality.MethodsWe retrospectively reviewed the records of 305 patients operated on for a diffuse peritonitis in two regional hospitals in the South-West Region of Cameroon over a 7 years period. The contributions of various causes of peritonitis to morbidity and mortality were analyzed.ResultsThe diagnosis of diffuse peritonitis was suggested on clinical ground only in more than 93 % of cases. The most common causes of diffuse peritonitis included peptic ulcer perforation (n = 69), complications of acute appendicitis (n = 53) and spontaneous perforations of the terminal ileum (n = 43). A total of 142 complications were recorded in 96 patients (31.5 % complication rate). The most common complications included wound dehiscence, sepsis, prolonged paralytic ileus and multi-organ failure. Patients with typhoid perforation of the terminal ileum carried a significantly higher risk of developing a complication (p = 0.002). The overall mortality rate was 15.1 %. The most common cause of death was septic shock. Differential analysis of mortality of various causes of peritonitis indicated that the highest contributors to death toll were typhoid perforation of terminal ileum (34.7 % of deaths), post-operative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %).ConclusionThe diagnosis of diffuse peritonitis can still rely on clinical assessment alone in the absence of sophisticated imaging tools. Peptic ulcer and typhoid perforations are still major contributors to death toll. Patients presenting with these conditions require specific attention and prevention policies must be reinforced.

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Section: Discussionmentioning

confidence: 79%

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

2016

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“…B. Acylaminopenicillin/Betalactamase-Inhibitor, Breitbandcephalosporin/Metronidazol oder Ertapenem. Die Kombination Ceftriaxon/Metronidazol stellt hier eine auch ö komomisch sinnvolle Wahl dar [26]. Die Gabe sollte idealerweise prä operativ, spä testens aber intraoperativ erfolgen [25,27].…”

Section: Antibiotikatherapieunclassified

Chirurgische Methodenwahl bei der Magenperforation

Stöltzing¹,

Emmel²,

Thon³

2007

Viszeralchirurgie

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ZusammenfassungDie eindrü ckliche Symptomatik der Magenperforation ist zu Beginn durch eine chemische Peritonitis bedingt, die nach 12-48 Stunden in eine bakterielle mit Zeichen der Sepsis ü bergeht. Die Perforationsursachen reichen von der Ulkuskrankheit ü ber Malignome bis hin zu Raritä ten. Die Inzidenz der Ulkusperforation liegt zwischen 4 und 8/100000 Patientenjahre, bei 1/4 der Patienten ist die Einnahme nicht-steroidaler Antiphlogistika beteiligt. Das perforierte Magenkarzinom ist insgesamt selten, der Anteil bei den wegen einer Magenperforation Operierten kann je nach Klinik ü ber 10 % liegen. Bei Spontanabdeckelung der Perforationsstelle ist im Ausnahmefall eine konservative Therapie mö glich; diese Entscheidung erfordert jedoch einen erfahrenen Chirurgen. Im Regelfall muss eine operative Herdsanierung und Dekontamination der Bauchhö hle durchgefü hrt werden. Zusä tzlich ist immer eine begleitende kalkulierte Antibiotikatherapie erforderlich. Die Kombination Ceftriaxon/Metronidazol ist hier eine sinnvolle Wahl und eine Kurzzeittherapie von 1-2 Tagen oft ausreichend. Die Wahl des Operationsverfahrens richtet sich nach der Perforationsursache. Heute ist beim Ulcus duodeni der ausschließliche Perforationsverschluss mit anschließender medikamentö ser Sä urehemmung und ggf. Eradikationstherapie bei positivem Helicobacter-Befund die Methode der Wahl. Ausnahmefä lle mit Indikation zur Magenresektion sind eine bekannte, trotz medikamentö ser Therapie rezidivierende Ulkuskrankheit, eine gleichzeitige Magenausgangsstenose, der Malignomverdacht oder technische Schwierigkeiten beim Perforationsverschluss. Auch beim perforierten Ulcus ventriculi ist eine reine Ü bernä hung nach der zu fordernden Ulkusexzision ausreichend. Große Ulzera und Malignomverdacht kö nnen hier ebenfalls zur Resektion zwingen. AbstractThe dramatic symptoms of gastric perforation are primarily caused by a chemical peritonitis; after 24 to 48 hours overgrowing bacterial infection will usually induce signs of sepsis. Most frequent underlying diagnoses are peptic duodenal and gastric ulcers, but also malignancies and other rare conditions. The incidence of perforated ulcer is 4 to 8/100,000 patient-years, and in 1/4 of them intake of non-steroidal antiphlogistics plays a role. Perforations of carcinomas are rare, but still account for up to 10 % of patients operated on for gastric perforation. As an exception, non-operative treatment can be performed in cases with spontaneous sealing, but a repeated patient review by a senior surgeon is mandatory. The regular therapy is operative closure and thorough decontamination of the abdominal cavity, combined with antibiotics. Ceftriaxone/metronidazole are a rational choice, and a short term treatment of 1-2 days is usually adequate. The operative procedure depends on the underlying cause. The standard today in perforated duodenal ulcer is simple closure with subsequent medical eradication therapy. Gastric resection is restricted to exceptional cases, i.e. known recurrent ulcer disease despite medical treat...

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Antibiotische Behandlung der sekund�ren Peritonitis in Deutschland

Abstract: Based on clinical, bacteriological, and pharmacoeconomic results, ceftriaxone in combination with metronidazole can be regarded as a first-line antimicrobial treatment of secondary peritonitis.

Cited by 2 publications

References 7 publications

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon

Chirurgische Methodenwahl bei der Magenperforation

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