Fecal peritonitis: Microbial adherence to serosal mesothelium and resistance to peritoneal lavage

Abstract

Fecal contamination of the peritoneal cavity is a serious and potentially life-threatening event. While numerous models have been developed to study the pathogenesis of intraabdominal infection, to date, most investigations have failed to focus on the adherence of the contaminants to the serosal mesothelium. In the present investigation, the cecal ligation and puncture technique (CLP) was performed in Sprague-Dawley rats to study the following: (a) the kinetics of microbial adherence to the serosal mesothelium, (b) the stability of the aerobic and anaerobic intraperitoneal/mesothelial populations, following extended saline lavage, and (c) the impact of antimicrobial lavage on the stability of the mesothelial microbial populations. The Enterobacteriaceae rapidly colonized the serosal mesothelium and were the predominant flora up to 4 hours post-CLP. After 8 hours, the Bacteroides fragilis group represented the predominant peritoneal wash and mesothelial-associated microorganisms. Extended saline lavage failed to significantly reduce the mesothelial microbial populations. While antimicrobial lavage produced an immediate decrease in mesothelial microbial recovery, the results were transitory and the microbial populations achieved or exceeded prelavage levels at 24 hours postlavage. Microbial colonization of the peritoneal mesothelial surface is a rapid and stable phenomena following penetrating injury to the distal bowel. The results further suggest that the mesothelial populations are resistant to intraperitoneal lavage.

Comparison of On-Demand vs Planned Relaparotomy Strategy in Patients With Severe Peritonitis

“…26,28 In our trial, the on-demand and planned relaparotomy strategies were equally apt to identify patients with remaining or new intra-abdominal infection after the index laparotomy. This also confirms that patients in the planned group were not more frequently determined to show positive findings due to differential verifica- (27) 27 (24) Cardiovascular disease 21 (18) 33 (29) Respiratory disease (chronic obstructive pulmonary disease) 14 (12) 17 (15) Renal disease 10 (9) 7 (6) Diabetes 9 (8) 11 ( …”

“…Other potential drawbacks of the planned relaparotomy strategy are the observed strong adherence of microbes residing in the peritoneum making them resistant to peritoneal lavage. 27 This reduces the effectiveness of the procedure and the damaging effects of lavage to the mesothelial layer may even reduce the innate resistance to infection. 26,28 In our trial, the on-demand and planned relaparotomy strategies were equally apt to identify patients with remaining or new intra-abdominal infection after the index laparotomy.…”

Phagocytosis by Emigrated, Intra-Abdominal Neutrophils Is Depressed during Human Secondary Peritonitis

“…Phagocytosis by PMNs results in ingestion and killing of a wide spectrum of microorganisms and is mediated by multiple cell surface receptors. The necessity for adequate ingestion and killing of microorganisms by phagocytes is demonstrated in a study carried out by Edmiston et al [5]: in a model based on cecal ligation and puncture technique in rats it was demonstrated that intraperitoneal/mesothelial microorganisms remained stable despite extended saline lavage. The study suggested that free particulates not firmly attached to the serosal mesothelium will be removed following lavage.…”

Extensive peritoneal lavage decreases postoperative C-reactive protein concentrations: a RCT

“…Lavage obviously decreases the microbial load of an infection, although bacteria sticking to the mesothelial cells are not removed [18]. The importance of removing debris and blood for the prevention of adhesion formation, although logic, has not been proven.…”