Microbial findings, sensitivity and outcome in patients with postoperative peritonitis a retrospective cohort study

Grotelueschen, Rainer; Luetgehetmann, Marc; Erbes, Johannes; Heidelmann, Lena M; Grupp, Katharina; Karstens, Karl; Ghadban, Tarik; Reeh, Matthias; Izbicki, Jakob R.; Bachmann, Kai

doi:10.1016/j.ijsu.2019.08.020

Cited by 12 publications

(12 citation statements)

References 36 publications

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“…However, the high rate of penicillin-nonsusceptible enterococci leads to the consideration of a specific anti-GPC EAT. The same conclusions were drawn in Germany from a cohort of 422 cases of POP with high proportions of E. faecium , all resistant to penicillins [ 25 ].…”

Section: Discussionsupporting

confidence: 63%

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Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019

Montravers,

Grall,

Kantor

et al. 2023

World J Emerg Surg

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Background Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT). Methods This retrospective monocentric analysis (1999–2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO. Results A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time. Conclusions We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO. Graphical Abstract

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Section: Discussionsupporting

confidence: 63%

“…Several authors have described the emergence of MDROs in IAIs [ 13 , 25 , 26 ]. Some did not provide any definition of MDRO [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019

Montravers,

Grall,

Kantor

et al. 2023

World J Emerg Surg

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“…Interestingly, the use of piperacillin was associated with therapeutic failure in a retrospective cohort of post-operative peritonitis. 20 The authors reported statistical links between mortality and resistant microorganisms involving not only piperacillin/sulbactam but also meropenem, tigecycline, cefotaxime/metronidazole and meropenem/vancomycin. However, several methodological issues limit the value of these observations, and it is difficult to extrapolate these conclusions to our current observations.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

Montravers¹,

Esposito-Farèse²,

Lasocki³

et al. 2021

Journal of Antimicrobial Chemotherapy

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Background Therapeutic failure is a frequent issue in the management of post-operative peritonitis. Objectives A post hoc analysis of the prospective, multicentre DURAPOP trial analysed the risk factors for failures in post-operative peritonitis following adequate source control and empirical antibiotic therapy in critically ill patients. Patients and methods Overall failures assessed post-operatively between Day 8 and Day 45 were defined as a composite of death and/or surgical and/or microbiological failures. Risk factors for failures were assessed using logistic regression analyses. Results Among the 236 analysed patients, overall failures were reported in 141 (59.7%) patients, including 30 (12.7%) deaths, 81 (34.3%) surgical and 95 (40.2%) microbiological failures. In the multivariate analysis, the risk factors associated with overall failures were documented piperacillin/tazobactam therapy [adjusted OR (aOR) 2.10; 95% CI 1.17–3.75] and renal replacement therapy on the day of reoperation (aOR 2.96; 95% CI 1.05–8.34). The risk factors for death were age (aOR 1.08 per year; 95% CI 1.03–1.12), renal replacement therapy on reoperation (aOR 3.95; 95% CI 1.36–11.49) and diabetes (OR 6.95; 95% CI 1.34–36.03). The risk factors associated with surgical failure were documented piperacillin/tazobactam therapy (aOR 1.99; 95% CI 1.13–3.51), peritoneal cultures containing Klebsiella spp. (aOR 2.45; 95% CI 1.02–5.88) and pancreatic source of infection (aOR 2.91; 95% CI 1.21–7.01). No specific risk factors were identified for microbiological failure. Conclusions Our data suggest a predominant role of comorbidities, the severity of post-operative peritonitis and possibly of documented piperacillin/tazobactam treatment on the occurrence of therapeutic failures, regardless of their type.

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“…However, in older reports, IAIs are responsible for about 25-30% of septicaemias and septic shock, and about 150,000 patients are treated with these indications in Germany annually [33,34]. In a more recent retrospective analysis, the overall mortality of post-operative peritonitis was 26%, with the highest mortality rate of 40% occurring in duodenal perforations [35]. Microbiologically, there is often a polymicrobial infection with facultative aerobic enteric bacteria (e.g., Escherichia coli, Klebsiella spp., Citrobacter spp., Enterococcus spp.)…”

Section: Definition and Epidemiologymentioning

confidence: 99%

The Need of Antimicrobial Stewardship in Post-Operative Infectious Complications of Abdominal Surgery

et al. 2022

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Background: Post-operative infection is a common complication following abdominal surgery. The two most common infections are secondary peritonitis and surgical site infections, which lead to increased perioperative morbidity, prolonged hospitalization, higher mortality rates, and increased treatment costs. In addition to surgical procedures, treatment is based on effective antibiotic therapy. Due to increasing antimicrobial resistance, the correct use of antimicrobials is becoming more complex. Many initiatives call for the implementation of an antimicrobial stewardship (AMS) programme to optimize anti-infective therapy. The review article summarizes current recommendations in anti-infective therapy of post-operative peritonitis and surgical site infections and highlights the importance of an AMS programme in abdominal surgery. Summary: Larger studies evaluating the benefit of AMS in abdominal surgery are lacking. However, national and international guidelines have formulated appropriate recommendations for the rational use of antibiotics in post-operative peritonitis and surgical site infections. The rate of post-operative infections can be significantly reduced by perioperative antibiotic prophylaxis. The increase in multidrug-resistant bacteria complicates anti-infective therapy for post-operative infections. Analysis of local susceptibility patterns helps choose an adequate empiric therapy. A high rate of extended-spectrum beta-lactamase-producing bacteria may necessitate the use of other reserve antibiotics in addition to carbapenems, which are approved for the treatment of complicated intra-abdominal infections. A key role for the AMS team is the subsequent de-escalation of antibiotic therapy which limits the use of unnecessary broad-spectrum antibiotics. Key Messages: The increase in multidrug-resistant bacteria poses challenges for abdominal surgery. Post-operative infections should be treated by an interdisciplinary team of surgeons and specialists for AMS.

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Microbial findings, sensitivity and outcome in patients with postoperative peritonitis a retrospective cohort study

Cited by 12 publications

References 36 publications

Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019

Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019

Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

The Need of Antimicrobial Stewardship in Post-Operative Infectious Complications of Abdominal Surgery

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