The Epidemiology of Intra-Abdominal Flora in Critically Ill Patients with Secondary and Tertiary Abdominal Sepsis

Ruiter, J. de; Weel, Jan; Manusama, Eric R.; Kingma, W. Peter; Voort, Peter H. J. van der

doi:10.1007/s15010-009-8249-6

Cited by 117 publications

(121 citation statements)

References 19 publications

(20 reference statements)

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“…The majority of polymicrobial fungal IAIs are caused by Candida albicans (12,13). However, IAIs caused by non-albicans Candida (NAC) species are becoming more common (14).…”

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confidence: 99%

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus

et al. 2016

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c Intra-abdominal polymicrobial infections cause significant morbidity and mortality. An experimental mouse model of Candida albicans-Staphylococcus aureus intra-abdominal infection (IAI) results in 100% mortality by 48 to 72 h postinoculation, while monomicrobial infections are avirulent. Mortality is associated with robust local and systemic inflammation without a requirement for C. albicans morphogenesis. However, the contribution of virulence factors coregulated during the yeast-tohypha transition is unknown. This also raised the question of whether other Candida species that are unable to form hyphae are as virulent as C. albicans during polymicrobial IAI. Therefore, the purpose of this study was to evaluate the ability of non-albicans Candida (NAC) species with various morphologies and C. albicans transcription factor mutants (efg1/efg1 and cph1/cph1) to induce synergistic mortality and the accompanying inflammation. Results showed that S. aureus coinoculated with C. krusei or C. tropicalis was highly lethal, similar to C. albicans, while S. aureus-C. dubliniensis, S. aureus-C. parapsilosis, and S. aureus-C. glabrata coinoculations resulted in little to no mortality. Local and systemic interleukin-6 (IL-6) and prostaglandin E 2 (PGE 2 ) levels were significantly elevated during symptomatic and/or lethal coinfections, and hypothermia strongly correlated with mortality. Coinoculation with C. albicans strains deficient in the transcription factor Efg1 but not Cph1 reversed the lethal outcome. These results support previous findings and demonstrate that select Candida species, without reference to any morphological requirement, induce synergistic mortality, with IL-6 and PGE 2 acting as key inflammatory factors. Mechanistically, signaling pathways controlled by Efg1 are critical for the ability of C. albicans to induce mortality from an intra-abdominal polymicrobial infection. I ntra-abdominal infection (IAI) is a broad term used to describe numerous infections caused by the invasion of microorganisms into the abdominal cavity. These infections can range from appendicitis to complicated peritonitis and are initiated by microbes entering the abdominal cavity through a variety of routes, including bowel perforation, laparotomy, intestinal hernias, and insertion of medical devices such as peritoneal catheters (reviewed in reference 1). These infections often are polymicrobial in nature, which complicates diagnosis and treatment. Accordingly, infections with multiple microbes can result in amplified pathogenicity, also known as "infectious synergism" (2-4), which may accelerate disease progression or protect microbes from host responses (5), resulting in higher morbidity and mortality (6, 7).Polymicrobial IAIs involving fungi result in mortality rates between 50 and 75%, compared to 10 to 30% for polymicrobial bacterial infections (8-11). The majority of polymicrobial fungal IAIs are caused by Candida albicans (12, 13). However, IAIs caused by non-albicans Candida (NAC) species are becoming more common (14). C. al...

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“…The majority of polymicrobial fungal IAIs are caused by Candida albicans (12,13). However, IAIs caused by non-albicans Candida (NAC) species are becoming more common (14).…”

mentioning

confidence: 99%

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus

et al. 2016

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“…As much as 60%, the anaerobic bacteria can be isolated in these infections. However, if there isn't any predisposing factor as strangulated hernia, these infections rarely observed [3,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…De Ruiter et al [6] have reported that isolated microorganism from 69% of cases with sepsis in abdominal fluid samples, and 70% of the isolated microorganism were mixed microorganisms that including anaerobic bacteria. Anaerobic and facultative anaerobic bacteria were commonly isolated in the peritoneal fluid samples by Stone et al [7].…”

Section: Discussionmentioning

confidence: 99%

Isolation of Anaerobic Bacteria from the Peritoneal Fluid of Patient who has Unstrangulated Umbilical Hernia

Doğan¹,

Kucukkartallar²,

Feyzioğlu³

et al. 2013

J Med Microb Diagn

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Aim: In cases of ventral hernia, in the presence of complications such as strangulation, a variety of intestinal bacteria can penetrate to peritoneal fluid and can cause peritonitis. However, these infections are rare in unstrangulated hernia cases. In this case report, it is emphasized that anaerobic bacteria and other bacteria can be isolated from patients with unstrangulated umbilical hernia to be cause of peritonitis. Case report:The 94-year-old female patient with unstrangulated ventral hernia was operated on as an emergency. The liquid that has accumulated in the hernia sac was taken for Gram stain and culture. Five ml peritoneal fluid was inoculated in the BACTEC plus Anaerobic F (Becton Dickinson-Maryland, USA) bottle. In addition, the fluid sample was inoculated on blood agar and EMB (eosin methylene blue) agar medium for aerobic isolation, and was inoculated on Schaedler agar medium (Oxoid, Hampshire, United Kingdom) for anaerobic isolation, and they was incubated at 37°C. Isolated facultative anaerobic bacteria were identified by using conventional methods; anaerobic bacterium was identified by using conventional methods, the API 20 a panels and An-Ident Discs tests.In the microbiological examination by Gram stain, no microorganism was observed. E. coli and Enterococcus spp. were identified as facultative anaerobic bacteria, and B. fragilis as anaerobic bacterium. After surgery of the patient, ceftriaxone and metronidazole were ordered. According to the culture results, ciprofloxacin was replaced by ceftriaxone in the treatment and the patient was discharged by healing. Conclusion:In patients with unstrangulated ventral hernia, anaerobic bacteria and other bacteria may be cause of peritonitis due to penetration of intestinal flora to peritoneal fluid. Isolation of Anaerobic

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“…These include persisting peritonitis despite adequate surgical and initial antimicrobial therapy [62], "persistent and tertiary chronic" peritonitis with distinct changes in immuno-responsiveness [63], and where there has been a prolonged course with microbiological shift from aerobic gram-negative bacteria towards gram-positive bacteria over time [64]. In a study of 69 patients with secondary peritonitis among whom 15 patients (22%) developed tertiary peritonitis, transition to tertiary peritonitis was associated with a higher Mannheim Peritonitis Index at the initial operation, higher severity of illness scores and CRP levels on the second postoperative day, higher relaparotomy rates with increased mortality (60% vs. 9%), and a longer ICU length of stay [65].…”

Section: Tertiary Peritonitismentioning

confidence: 99%

Management of abdominal sepsis — a paradigm shift?

Leppäniemi¹,

Kimball²,

Laet³

et al. 2015

Anaesthesiol Intensive Ther

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The abdomen is the second most common source of sepsis and secondary peritonitis. The most common causes of abdominal sepsis are perforation, ischemic necrosis or penetrating injury to the abdominal viscera. Management consists of control of the infection source, restoration of gastrointestinal tract (GI) function, systemic antimicrobial therapy and support of organ function. Mortality after secondary peritonitis is still high. Excluding patient-related factors such as age or co-morbidities that can not be influenced at the time of intervention, delay to surgical intervention and inability to obtain source control are the main determinants of outcome. In patients with severe physiological derangement or difficult intraperitoneal conditions, where a prolonged operation and complete anatomical repair may not be possible or appropriate, it is becoming increasingly popular to utilize a damage control strategy with abbreviated laparotomy and planned reoperations. The main components of damage control laparotomy for secondary peritonitis are postponing the reconstruction of intestinal anastomoses to a second operation (deferred anastomosis) and leaving the abdomen open with some form of temporary abdominal closure (TAC). Advances in the management techniques of the open abdomen and new negative pressure-based TAC-devices have significantly reduced the previously observed prohibitive morbidity associated with open abdomens. These advancements have led to current fascial closure rates after TAC approaching 90%. The cornerstones of appropriate antimicrobial therapy are the timing, spectrum and dosing of antibiotics. Enteral nutrition should be started as soon as possible in hemodynamically stable patients but withheld when the patient is on a significant dose of vasopressors or whenever GI hypoperfusion is suspected. Timely source control with appropriate use of antimicrobial agents and early intensive care offers the best chance of survival for patients with abdominal sepsis. The introduction of the concept of damage control to the management of secondary peritonitis represents a paradigm shift in the same way as in management of major trauma. Although limited and repeated surgical interventions have been shown to be safe, the actual benefits need to be demonstrated in controlled studies.

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The Epidemiology of Intra-Abdominal Flora in Critically Ill Patients with Secondary and Tertiary Abdominal Sepsis

Abstract: The composition of the intra-abdominal flora found in critically ill patients with abdominal sepsis varies depending on the location of the perforation. The efficacy of combined surgical and antibiotic treatment was 87% in 4 weeks for AGNB.

Cited by 117 publications

References 19 publications

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus

Isolation of Anaerobic Bacteria from the Peritoneal Fluid of Patient who has Unstrangulated Umbilical Hernia

Management of abdominal sepsis — a paradigm shift?

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