Spectrum adequacy of antibiotic regimens for secondary peritonitis: a retrospective analysis in intermediate and intensive care unit patients

Abstract

Background Secondary peritonitis requires surgical source control and adequate antimicrobial treatment. Antimicrobial regimens are usually selected according to local susceptibility data of individual pathogens against single agents, but this neglects both the polymicrobial nature of the infection and the use of combination therapy. We analysed the probability of common regimens to cover all relevant pathogens isolated in one patient (“spectrum adequacy rate”, SAR) in a real-life data set.Methods Data from 242 patients with secondary peritonitis (88 community acquired, 154 postoperative cases) treated in our IMCU/ICU were obtained retrospectively. The relative frequency of pathogens, resistance rates and the SAR were analysed using the free software R.ResultsEnterococci were isolated in 47.1 % of all patients, followed by Escherichia coli (42.6 %), other enterobacteriaceae (33.1 %), anaerobes (29.8 %) and Candida spp. (28.9 %). Resistance patterns were consistent with general surveillance data from our hospital. The susceptibility rates and SAR were lower in postoperative than in community acquired cases. The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin. When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised. As for Candida spp., the SAR of fluconazole was 81.9–87.5 %.ConclusionsThis study demonstrates a rational approach to assess the adequacy of antimicrobial regimens in secondary peritonitis, which may help to adjust local guidelines or to select candidate regimens for clinical studies.

What every intensivist should know about the management of peritonitis in the intensive care unit

“…( 9 , 10 ) However, MDR is also increasing in community-acquired infections, with extended-spectrum beta-lactamase (ESBL)-producing bacteria being the most globally widespread problem, although there is important regional variation in its prevalence. ( 11 , 12 ) In nosocomial infections, ( 4 , 9 , 13 ) both Gram-positive and Gram-negative pathogens that have MDR may be encountered, and these include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and ESBL-producing Enterobacteraceae but also carbapenem-resistant Enterobacteraceae (CRE), MDR Pseudomonas aeruginosa and Acinetobacter spp., which also have important geographical variations.…”

“Aerogels of enzymatically oxidized galactomannans from leguminous plants: Versatile delivery systems of antimicrobial peptides and enzymes”

“…Typhimurium, H. alvei and E. cloacae; all responsible for nosocomial infections that can lead to lifethreatening bacteremia (Alexopoulou et al, 2016;Kim et al, 2015;Steinbach, Töpper, Adam, & Kees, 2015).…”

“…A similar experiment was carried out on a strain of S. marcescens, a species recognized to cause human clinical diseases, with a multidrug-resistance profile (Zavascki, Goldani, Li & Nation, 2007). Following the same protocol as above, we have evaluated four other Gram-negative bacterial species involved in nosocomial infections, that can be fatal, mostly if infected patients are elderly, young, or people with depressed immune systems (Alexopoulou et al, 2016;Kim et al, 2015;Steinbach et al, 2015). The bacterial strains were the following: S. Typhimurium (Fig.…”

Antibiotic sensitivity in correlation to the origin of secondary peritonitis: a single center analysis

“…Since Enterococci are resistant to many antibiotics and Meropenem is only of limited effectiveness, therapy with Tigecycline or Piperacillin/Sulbactam should be considered if Enterococci are revealed in the culture. In previous studies, Tigecycline in combination with Gentamicin or Ciprofloxacin was found to be effective against Enterobacteriaceae 29 .…”