Antibiotic Treatment for Surgical Peritonitis

Mosdell, Dale M.; Morris, Don M.; Voltura, Anna; Pitcher, David E.; Twiest, Melvin W.; Milne, Robert W.; Miscall, Brian G.; Fry, Donald E.

doi:10.1097/00000658-199111000-00001

Cited by 264 publications

(133 citation statements)

References 13 publications

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“…While Mosdell et al found appendicular perforation as most common cause for secondary peritonitis, also been confirmed by D Genne et al in their study. 2,11,16 The results of culture and sensitivity of the peritoneal fluid at laparotomy revealed that organisms isolated were E. coli (50%) followed by Klebsiella (24%), other organisms found were streptococci group D (12%), staphylococcus aureus (8%), Citrobacter (4%), and Candida in 10% patients and 16% patients revealed sterile culture. None of the 50 patients of peritonitis showed anaerobic isolation in present study due to noninclusion of suitable culture media for anaerobes and that seems to have become the major limitation of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies including Mosdell et al found that in appropriate initial antibiotic coverage was highly associated with persistent infection. 11 Hence, this study was done to study various organism found in cases of perforation peritonitis of difference sites of gastrointestinal tract and their sensitivity pattern, so as to form a recommendation for most effective empirical antibiotic regimen, so as to reduce morbidity and mortality. The study was done to identify the type of organism present in bowel perforation and their sensitivity pattern to different antibiotics.…”

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confidence: 99%

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Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

et al. 2017

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Background: Peritonitis is a common emergency encountered by surgeons the world over. Despite a better understanding of pathophysiology, advances in diagnosis, surgery, antimicrobial therapy and intensive care support, peritonitis remains a potentially fatal affliction. Intra-abdominal sepsis is important causes of mortality and morbidity. The treatment is based on rapid fluid resuscitation, initiation of antibiotic therapy and surgical intervention. The antibiotic chosen must cover the most frequently expected bacterial species depending upon the site of perforation. Objectives of the study was done to identify the type of organism present in bowel perforation and their sensitivity pattern to different antibiotics. A guideline will be framed for advising antibiotics to be used for different kinds of perforation.Methods: This was a prospective study of one year on 50 patients of secondary peritonitis due to bowel perforation, conducted in Amaltas institute of Medical Sciences, Dewas.Results: This study included 50 patients with an average age of 36 years (range: 3 days-75 years). There were 40 males and 10 females. The mean duration of hospitalization was 10.6 days (range: 3-25 days) with predominant site of perforation was ileum. E. coli emerged as main pathogenic microbe even in site specific culture, was closely followed by Klebsiella. A combination of third generation cephalosporins with sulbactam and metronidazole has been the most promising therapy to treat secondary bacterial peritonitis due to bowel perforation. It needs to be emphasized that although the sensitivity studies reveal an edge for meropenem over cefaperazone sulbactam, yet the preference of cephalosporin with sulbactam over meropenem is justified, considering the economic constraints and with a suitable foresight, to keep meropenem as a reserve drug because trends indicate that our microbes are fast becoming resistant to the promising combination of third generation cephalosporin with sulbactam and metronidazole.Conclusions: This study suggests that the current recommended empirical antibiotics need to be reassessed.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

et al. 2017

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“…One epidemiological survey of patients with complicated intra-abdominal infections found an overall mortality rate of 6.0%, a postoperative abscess rate of 10.2%, and a re-operation rate of 12.5% [6]. Nonetheless, these data reflect the outcome of a heterogeneous group of patients at variable risks of treatment failure and death.…”

Section: Mazuski Imentioning

confidence: 99%

“…It is interesting that the source of the infection is not found to be an independent risk factor in these analyses. Thus, the lower mortality rate of patients with complicated appendicitis [6] may be related to their younger age and healthier condition as to the extent of peritoneal contamination, compared to patients with other types of intra-abdominal infections.…”

Section: Characterizing Patient Riskmentioning

confidence: 99%

“…is more common in patients with nosocomial intra-abdominal infections [17], and their isolation is a risk factor for treatment failure and death [61][62][63]. Inadequate empiric antimicrobial therapy is also a risk factor for treatment failure and death in patients with intra-abdominal infections [6,17,36] and is a strong predictor of mortality in critically ill patients with nosocomial pneumonia [64]. Thus, it would seem reasonable to cover Enterococcus spp.…”

Section: Antimicrobial Therapy For Higher-risk Patients With Intra-abmentioning

confidence: 99%

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Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Mazuski

2005

Surgical Infections

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Methods: Based on a review of the literature, treatment guidelines, and expert opinion, the challenges of managing patients with complicated intra-abdominal infections are summarized using a patient stratification approach: "Lower risk" of treatment failure and death vs. "higher risk."Results: Risk factors for treatment failure and death can be grouped into several categories, including the patient's pre-existing medical comorbidities and physiological response to the infection, the extent of the intra-abdominal infection, and the presence of specific pathogenic microorganisms. These latter factors may be more useful than the Acute Physiology and Chronic Health Evaluation (APACHE) II score in evaluating specific management strategies for patients with complicated intra-abdominal infections. The principal goal of treatment in lower-risk patients is to avoid morbidity related to source control procedures and antimicrobial therapy. Limitation of the scope of source control procedures and utilization of short-duration, narrow-spectrum, low-toxicity antimicrobial regimens is advisable to avoid adverse drug reactions and selection of resistant organisms. For higher-risk patients, the goal is to develop improved management modalities, so that morbidity and mortality are reduced. The recommended approach for higher-risk patients is to identify the most appropriate source control procedure and antimicrobial therapy, as dictated by the patient's specific risk factors, and to utilize the optimal tools of critical care medicine to treat these critically ill, septic patients. The emergence of bacterial resistance also must be considered when selecting antimicrobial therapy for both low risk and high risk patients with intra-abdominal infections. Because aminoglycoside regimens are becoming less favored, and optimal therapeutic strategies have not been standardized, the use of new treatment options (e.g., tigecycline) may be valuable when managing patients with intra-abdominal infections. especially for resistant isolates.Conclusions: The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-

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Prognosis and Treatment of Peritonitis

Koperna

Schulz²

1996

Arch Surg

138

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The prognosis in peritonitis is decisively influenced by the health status of the patient at the beginning of treatment and by any concomitant risk factors. As a result, a fairly accurate prediction of the outcome of the disease can initially be made on the basis of the APACHE II score and the MOSF score according to Goris. However, the certainty that severely ill patients with high scores often die has little clinical relevance, since it does not provide any therapeutic alternatives to the attending physician. The decision to perform a relaparotomy must be made as soon as possible, at least before MOSF emerges. Already existing MOSF will lead to the "point of no return."

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Antibiotic Treatment for Surgical Peritonitis

Cited by 264 publications

References 13 publications

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Prognosis and Treatment of Peritonitis

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