The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report

Abstract

A 59 year-old male patient diagnosed with cecal cancer, surgically treated -right hemicolectomy with ileotransverse anastomosis suddenly presented in the 5th postoperative day fever, hypotension, abdominal pain, and vomiting faeces. The intraoperatory diagnosis was postoperative peritonitis due to anastomotic leak; exploratory laparotomy, segmental colectomy, transverse ileostomy, lavage and drainage were performed. Before surgical reintervention, blood cultures were performed and empirical antiinfective therapy was started using ertapenem, vancomycin and fluconazole. A postoperative ICU admission was decided due to septic shock and MODS: acute respiratory failure, acute cardio-circulatory failure, coagulopathy and metabolic acidosis, which required complex treatment: ventilatory support, haemodynamic optimization, antibiotics, analgesia, deep venous thromboembolism prophylaxis, nutrition. In the 3 rd day after reintervention, microbiological examination of the intraoperatory collected peritoneal fluid identified a triple germ association: Escherichia coli, Enterococcus faecalis and Proteus mirabilis, which were sensitive to the chosen antibiotics; the blood cultures were sterile. After 3 days of severe evolution, the multiple organ dysfunction gradually improved and the patient was discharged from ICU 10 days later.