Identification of Patients at Risk for Development of Tertiary Peritonitis on a Surgical Intensive Care Unit

Chromik, Ansgar M.; Meiser, Andreas; Holling, J; Sülberg, D.; Daigeler, Adrien; Meurer, Kirsten; Vogelsang, Heike; Seelig, Matthias H.; Uhl, Waldemar

doi:10.1007/s11605-009-0882-y

Cited by 48 publications

(38 citation statements)

References 21 publications

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“…Today, an involvement of drug-resistant or difficult-to-treat bacteria is not uncommon in patients with post-operative or tertiary peritonitis or necrotizing pancreatitis, pre-treated with antibiotic [26,27,28]. The results of this non-interventional study, with the largest number of patients with pre-treated cIAI as yet, are in line with this trend.…”

Section: Discussionsupporting

confidence: 71%

Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Eckmann¹,

Heizmann²,

Leitner³

et al. 2011

Chemotherapy

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Background: Only few data are available on the efficacy of tigecycline in critically ill patients. Methods: This prospective, multicenter, non-interventional study investigated the efficacy and safety of tigecycline in hospitalized, severely ill patients with complicated intra-abdominal infections (cIAI) and/or complicated skin and soft tissue infections (cSSTI). Documentation included diagnosis, clinical findings, Acute Physiology and Chronic Health Evaluation II score, laboratory assessments, surgery, clinical outcomes, and adverse events. Results: Six hundred and fifty-six patients (mean Acute Physiology and Chronic Health Evaluation II score 19.1) with cIAI (41%), cSSTI (16%), multiple infection sites (13%) and/or other severe infections (31%) received tigecycline – 51% as monotherapy – due to failure of previous antibiotics (55%) or since resistant pathogens were suspected or proven (45%); clinical cure/improvement rates were 75, 82, 76 and 67% for cIAI, cSSTI, other severe infections and multiple infection sites, respectively. Drug-related adverse events occurred in 6.7% of patients. Conclusions: The efficacy and safety of tigecycline was demonstrated in a population of severely ill patients with complicated infections.

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Section: Discussionsupporting

confidence: 71%

Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Eckmann¹,

Heizmann²,

Leitner³

et al. 2011

Chemotherapy

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“…More specifically, MPI and the Peritonitis Index of Altona (P _ IA-II) are used as scoring systems for [4,5]. In addition, MPI, SAPS II and APACHE II have recently been shown to predict the development of postoperative peritonitis among patients with secondary peritonitis [13]. Causes of secondary peritonitis have changed during the last century.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of the mortality of postoperative intraabdominal infections

et al. 2010

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“…Tertiary peritonitis was diagnosed on the 3rd-12th days (median -5 days) in 20 (18.3%) patients. Criteria for diagnosis of TP were: the persistence of peritoneal symptoms despite the adequate surgical elimination of the infectious focus, the presence of nosocomial microflora (Citrobacter Freundii, Acinetobacter Baumannii, Staphylococcus viridans, Pseudomonas spp., Candida spp., Geotrichum candidum) in peritoneal exudate, multi-organ failure (MOF) and stay in ICU > 3 days [11]. Postoperative mortality in the whole cohort of patients was 30.2%.…”

Section: Methodsmentioning

confidence: 99%

Changes in Humoral and Cellular Immunity in Tertiary Peritonitis

Matviychuk

2017

Galician med. j.

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The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of secondary and tertiary peritonitis. Materials and methods. The research enrolled 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Changes in humoral and cellular immunity were evaluated by serial blood tests for the determination of leukocyte count, the relative number of lymphocytes, Ig A, M, and G levels, as well as by counting the phagocytic index, the phagocytic number and the leukocyte intoxication index. The statistical processing of the obtained data was made using the STATISTICA 5.0 software (StatSoft, USA). Results. All the patients were divided into 2 groups: the group of patients with secondary peritonitis (n=89) and the group of patients with tertiary peritonitis (n=20). In the development of tertiary peritonitis, leukocytosis, relative lymphocytopenia and high values of the leukocyte intoxication index persisted during the entire observation period. In tertiary peritonitis, the phagocytic index was significantly lower only on the day of hospitalization. In the group of tertiary peritonitis, the phagocytic number decreased significantly until the 7th day after surgery. Ig A, M and G levels were lower since admission and subsequently decreased as compared to the results in the group of patients with secondary peritonitis. Conclusions. 1. Tertiary peritonitis is the most severe form of abdominal sepsis with high rates of mortality and rather difficult early diagnosis. 2. With the development of tertiary peritonitis, leukocytosis increases and relative lymphocytopenia develops. 3. The reduction in phagocytic index is indicative for the prognosis of tertiary peritonitis. 4. Ig A and M levels are significantly lower, and the leukocyte intoxication index is high at the time of hospitalization in patients who subsequently develop tertiary peritonitis. Problem statement and analysis of the recent researchFor decades, abdominal sepsis remains an actual and still unresolved problem of emergency surgery [1,2]. Present contradictions in the approaches to diagnosis and treatment of its most frequent manifestation -secondary peritonitis (SP) -indicate its special complexity [3,4]. The nature of the immune response, as one of the leading components of the pathogenesis of sepsis, allows the surgeon to evaluate not only the efficacy of treatment, but also to predict the further course of the disease [5,6,7,8]. Nowadays, the patient's immune status in tertiary peritonitis (TP) is not sufficiently studied and requires in-depth analysis, namely from the perspective of prediction of changes in its parameters [9,10].The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of SP and TP.

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Identification of Patients at Risk for Development of Tertiary Peritonitis on a Surgical Intensive Care Unit

Abstract: The MPI at IO as well as CRP and SAPS II at the second postoperative day helps to identify patients at risk for tertiary peritonitis.

Cited by 48 publications

References 21 publications

Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Prospective, Non-Interventional, Multi-Centre Trial of Tigecycline in the Treatment of Severely Ill Patients with Complicated Infections – New Insights into Clinical Results and Treatment Practice

Prognostic factors of the mortality of postoperative intraabdominal infections

Changes in Humoral and Cellular Immunity in Tertiary Peritonitis

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