Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis

Abstract

Introduction: Persistent peritonitis is a frequent complication of secondary peritonitis requiring additional reoperations and antibiotic therapy. This situation raises specific concerns due to microbiological changes in peritoneal samples, especially the emergence of multidrug-resistant (MDR) strains. Although this complication has been extensively studied, the rate and dynamics of MDR strains have rarely been analysed. Methods: We compared the clinical, microbiological and therapeutic data of consecutive ICU patients admitted for postoperative peritonitis either without subsequent reoperation (n = 122) or who underwent repeated surgery for persistent peritonitis with positive peritoneal fluid cultures (n = 98). Data collected on index surgery for the treatment of postoperative peritonitis were compared between these two groups. In the patients with persistent peritonitis, the data obtained at the first, second and third reoperations were compared with those of index surgery. Risk factors for emergence of MDR strains were assessed.

Microbiological Spectre of Tertiary Peritonitis as a Component of Its Diagnostics and Treatment

“…and P. aeruginosa in 11,1 % and 11,9 % respectively [26]. In other works, fraction of nosocomial MDR reached 84,8 %, but just 14 % in case of TP [23]. Our findings of MDR pathogens make up for 35,3 % in SP group, and 28,7 % of strains in TP group.…”

“…In case of candidous TP, mortality reaches 70 % [11]. Peritoneal sampling during TP had shown positive culturing of albicans-subspecies in 12 % of cases, non-albicans-subspecies -in 3 % [23]. In TP group, we had seen a remarkable shift of the ratio of "albicans/non-albicans" subspecies in favour of the latter.…”

“…Diversities and sometimes discrepancies in microbial spectres of peritonites could be explained by differences in regional protocols/standards of antibiotic treatment and structure of morbidity of given population. Yeast strains comprise 22-41 % in exudate of SP and 17 % of all nosocomial isolates in ICU [23]. Isolation of Candida from intra-abdominal cultures is successful in 57 % of cases and is associated with increased mortality [24].…”

“…Isolation of Candida from intra-abdominal cultures is successful in 57 % of cases and is associated with increased mortality [24]. In the structure of obtained fungal cultures during SP, Candida albicans was seen in 74 %, Candida glabrata -17 %; remaining 9 % included: Candida inconspicua, Candida parapsilosis, Candida tropicalis, Candida zeylanoides, Geotrichum candidum [23]. In our research, in SP group we observed lesser percentage of Candida albicans and very moderate -of Candida non-albicans in comparison to TP group.…”

Management of Intra-Abdominal Infections

“…However, it represents an evolution and complication of secondary peritonitis [8][9][10]. The term "ongoing peritonitis" [11] or "persistent peritonitis" [12] may better indicate that it is not a different disease to secondary peritonitis, but rather represents secondary peritonitis lasting longer and harboring other (selected and more resistant) pathogens.…”