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Unver Ulusoy T, Karakoç Parlayan HN, Altın N, Sarıkaya B, Öztürk B, Şencan İ. Comparative Analysis of Demographic and Clinical Findings in Spontaneous, Peritoneal Dialysis-Related, and Secondary Bacterial Peritonitis. Cureus 2024; 16:e55445. [PMID: 38567242 PMCID: PMC10987013 DOI: 10.7759/cureus.55445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
Background This study aims to contribute to peritonitis management strategies by comparing the demographic, clinical, and laboratory characteristics of patients diagnosed with spontaneous bacterial peritonitis (SBP), peritoneal dialysis-related peritonitis (PDrP), and secondary peritonitis. Methods This study included 86 patients diagnosed with peritonitis between 2016 and 2022. Patients were categorized and compared as SBP, PDrP, and secondary peritonitis. Results SBP was diagnosed in 36% of patients, secondary peritonitis in 36% and PDrP in 28%. The mean age of patients with PDrP is 43.71 ± 14.74, which is significantly lower compared to those with SBP and secondary peritonitis (p<0.001). Patients with hypertension (HT), chronic kidney disease (CKD), and those undergoing dialysis most commonly have PDrP whereas those without HT, without CKD, and not undergoing dialysis are most often diagnosed with secondary peritonitis (p=0.002, p<0.001, p<0.001). In peritoneal fluid cultures, the growth of Gram-positive bacteria was most commonly identified in patients with PDrP, while the growth of Gram-negative bacteria was most frequently seen in patients with secondary peritonitis (p=0.018). CRP levels and sedimentation rates were found to be higher in patients with secondary peritonitis (p<0.001, p=0.003). Conclusion The distinct characteristics observed across different types of peritonitis underscore the importance of tailored approaches to diagnosis and treatment. Parameters such as CRP levels, sedimentation rates, and patient age could serve as valuable indicators in discerning between various types of peritonitis. When selecting empirical antibiotic therapy, it's crucial to consider coverage for Gram-positive pathogens in cases of PDrP and Gram-negative pathogens in secondary peritonitis.
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Affiliation(s)
- Tülay Unver Ulusoy
- Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - Hanife Nur Karakoç Parlayan
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - Nilgün Altın
- Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - Büşra Sarıkaya
- Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - Büşra Öztürk
- Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - İrfan Şencan
- Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR
- Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
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DiDomenico AE, Jacob ME, Stowe DM, Gruber EJ. Diagnostic utility of the total nucleated cell count for differentiation of septic and sterile peritoneal effusions in dogs. Vet Clin Pathol 2024; 53:104-110. [PMID: 38321629 DOI: 10.1111/vcp.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/16/2023] [Accepted: 10/16/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Rapid and accurate diagnosis of septic peritonitis is critical for initiating appropriate medical and surgical management. OBJECTIVES The aim of this study was to determine the diagnostic utility of the total nucleated cell count (TNCC), absolute neutrophil count, neutrophil percentage, and total protein (TP) to distinguish septic versus non-septic peritoneal effusions in dogs. METHODS Electronic medical records were retrospectively searched for peritoneal fluid samples from 2008 to 2018 and classified as septic or non-septic based on bacterial culture and/or cytology results. Receiver operator characteristic curves (ROCs) were used to describe the overall diagnostic utility of each test, with optimal cutpoints analyzed to dichotomize continuous variables. Positive and negative likelihood ratios were calculated at these cutpoints. RESULTS A total of 166 unique samples, including 87 septic and 79 non-septic peritoneal effusions, were included. There were no significant differences in dog sex, age, or days hospitalized between groups. Septic effusions had significantly higher TP, TNCC, absolute neutrophil count, and neutrophil percentage compared with non-septic effusions. The area under the curve of the ROC curves was TNCC (0.80), absolute neutrophil count (0.80), neutrophil percentage (0.64), and TP (0.63). For TNCC and absolute neutrophil count, optimal cutoffs were 17.13 × 103 cells/μL and 19.88 × 103 cells/μL, resulting in positive and negative likelihood ratios of 2.39 and 0.28 and 2.85 and 0.28, respectively. CONCLUSIONS Total nucleated cell counts and absolute neutrophil counts aid in the differentiation of septic and non-septic peritoneal effusions with similar diagnostic utility but are not sufficiently sensitive or specific to use without concurrent microscopic evaluation.
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Affiliation(s)
- Amy E DiDomenico
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
| | - Megan E Jacob
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
| | - Devorah M Stowe
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
| | - Erika J Gruber
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina, USA
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Saleem M, Maqsood M, Iftikhar H, Haria D, Arif H. Peritoneal Dialysis-Related Recurrent Rhodococcus corynebacterioides Peritonitis: A Case Report and Review of Literature. Cureus 2023; 15:e43423. [PMID: 37706134 PMCID: PMC10497068 DOI: 10.7759/cureus.43423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Rhodococcus corynebacterioides is a Gram-positive bacterium known to cause bacteremia and oligoarthritis. There have been only a few case reports in the literature that describe its association with peritoneal dialysis (PD)-related peritonitis. We report a case of recurrent peritonitis caused by R. corynebacterioides. The patient presented with abdominal pain, and PD fluid analysis was positive for infection, with cultures growing R. corynebacterioides. The patient was treated with multiple courses of intraperitoneal antibiotics due to recurrent episodes of PD-associated peritonitis from this bacterium, ultimately necessitating the removal of the PD catheter and the transition to hemodialysis.
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Affiliation(s)
- Maryam Saleem
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Maryam Maqsood
- Internal Medicine, Mayo Hospital, Lahore, PAK
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Hassaan Iftikhar
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Dhiren Haria
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
| | - Hamza Arif
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
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Dumitrascu CO, Gherghe M, Costache M, Cretu B, Cirstoiu C. The Role of Serum and Peritoneal Biomarkers in Predicting Sepsis and Septic Multiorgan Failure in Patients With Secondary Peritonitis. Cureus 2023; 15:e41724. [PMID: 37441100 PMCID: PMC10335813 DOI: 10.7759/cureus.41724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose Secondary peritonitis is still one of the most important causes of severe sepsis in the world; therefore, it is of utmost importance to identify biomarkers that could be employed for the purpose of selecting patients at high risk for developing life-threatening complications after emergency surgery. In view of this quest, our study seeks to reveal the possible role for serum and peritoneal concentrations of selected biomarkers, specifically presepsin, procalcitonin, monocyte chemoattractant protein-1 (MCP-1), high mobility group box 1 protein (HMGB-1) and interleukins (IL-6, -8, -10), in early prediction of sepsis and septic multiorgan failure for patients with secondary peritonitis. Methods We prospectively observed 32 selected patients with secondary peritonitis that underwent emergency surgery. Blood and peritoneal fluid samples were drawn at the time of surgery (T0), and after that, blood samples were taken at 24 (T1) and 48 (T2) hours postoperatively. Cytokines concentrations were determined using a sandwich enzyme-linked immunosorbent assay (ELISA), a non-competitive variant, both in peritoneal fluid and serum. For determining whole blood concentration of presepsin and procalcitonin, PATHFAST™ assays (Polymedco, Cortlandt, New York) were used, based on the principle of non-competitive chemiluminescent enzyme immune-assay (CLEIA). The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of University Emergency Hospital Bucharest (no. 40325/6 April 2023). Results We found significant elevations in the peritoneal concentrations of interleukins 6, 8, 10, HMGB-1, and MCP-1 in all patients with secondary peritonitis at the moment of surgery; however, no clear correlation could be made based on this data with patient evolution. With regards to blood concentrations of the aforementioned serum cytokines and presepsin, procalcitonin (as already established markers of sepsis), our results showed good predictive value of presepsin for developing sepsis and septic multiorgan failure from the first hours in this patient category. All other biomarkers, despite having higher concentrations than baseline, in particular at 24-48 hours after surgery, had unpredictable dynamics that couldn't be correlated with the severity of the disease. Conclusion Cytokine production is the mainstay in developing sepsis and septic multiorgan failure in patients with secondary peritonitis; therefore, studying the dynamics of said cytokines seems of interest in finding tools to predict the development of sepsis or sepsis-related mortality. However, at the time, there seemed to be no clear correlation between the values of these cytokines and the development of complications.
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Affiliation(s)
- Clementina O Dumitrascu
- Anesthesiology and Critical Care Department, University Emergency Hospital of Bucharest, Bucharest, ROU
| | - Mihai Gherghe
- Anesthesiology and Critical Care Department, University Emergency Hospital of Bucharest, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology Department, University Emergency Hospital of Bucharest, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital of Bucharest, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital of Bucharest, Bucharest, ROU
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Würstle S, Hapfelmeier A, Karapetyan S, Studen F, Isaakidou A, Schneider T, Schmid RM, von Delius S, Gundling F, Burgkart R, Obermeier A, Mayr U, Ringelhan M, Rasch S, Lahmer T, Geisler F, Turner PE, Chan BK, Spinner CD, Schneider J. Differentiation of Spontaneous Bacterial Peritonitis from Secondary Peritonitis in Patients with Liver Cirrhosis: Retrospective Multicentre Study. Diagnostics (Basel) 2023; 13:diagnostics13050994. [PMID: 36900138 PMCID: PMC10000989 DOI: 10.3390/diagnostics13050994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, >30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score ≥ 45) and high-risk group (score < 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis.
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Affiliation(s)
- Silvia Würstle
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany
| | - Siranush Karapetyan
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany
| | - Fabian Studen
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andriana Isaakidou
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Tillman Schneider
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Roland M. Schmid
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stefan von Delius
- Department of Internal Medicine II, RoMed Hospital Rosenheim, Pettenkoferstr. 10, 83022 Rosenheim, Germany
| | - Felix Gundling
- Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Bogenhausen Hospital of the Munich Municipal Hospital Group, Englschalkinger Straße 77, 81925 Munich, Germany
- Department of Internal Medicine II, Klinikum am Bruderwald, Sozialstiftung Bamberg, Buger Straße 80, 96049 Bamberg, Germany
| | - Rainer Burgkart
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas Obermeier
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marc Ringelhan
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Paul E. Turner
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
- Program in Microbiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Benjamin K. Chan
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Correspondence:
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Ramteke H, Deshpande SG, Bhoyar R. The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India. Cureus 2023; 15:e36620. [PMID: 37102001 PMCID: PMC10123196 DOI: 10.7759/cureus.36620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Acute secondary peritonitis due to hollow viscus perforation is a life-threatening surgical condition with significant morbidity and mortality, depending on the severity with outcomes that differ in the Western and developing world. Various scoring systems have been developed to assess the severity and its relation to morbidity and mortality. We conducted this study to evaluate the role of the Mannheim peritonitis index (MPI) in predicting outcomes in perforation peritonitis patients in a rural hospital in India. Materials and methods A prospective study of 50 patients with hollow viscus perforation with secondary peritonitis presented to the emergency department, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, from 2016 to 2020. Each operated patient was scored according to the MPI to predict mortality. Results The majority of the patients were discharged uneventfully and about 16% (8/50) of the patients expired. The patients with an MPI score of more than 29 had maximum mortality of 62.5%. Mortality was seen in 37.5% of the patients with MPI scores between 21 and 29, whereas no mortality was recorded in patients with an MPI score of 21. Higher mortality was associated with age greater than 50 years (p=0.007), the presence of malignancy (p=0.013), colonic perforation (p=0.014), and fecal contamination (p=0.004). There was no significant correlation with gender (p=0.81), the presence of organ failure (p=1.6), delayed presentation, i.e., preoperative duration >24 hours (p=0.17), and the presence of diffuse peritonitis (p=0.25). Conclusion MPI is a specific, easily reproducible, and less cumbersome scoring method for predicting mortality in patients with hollow viscus perforation (secondary) peritonitis with minimal laboratory investigations. Higher scores correlate with a poorer prognosis and need intensive management, making use of MPI in clinical practice relevant and beneficial, especially in resource-poor settings.
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Affiliation(s)
- Harshal Ramteke
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swati G Deshpande
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rohini Bhoyar
- Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences, Nagpur, IND
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Lebedev NV, Klimov AE, Shadrina VS, Belyakov AP. [Choice of surgical approach and option for completing laparotomy in widespread peritonitis]. Khirurgiia (Mosk) 2023:41-46. [PMID: 37916556 DOI: 10.17116/hirurgia202310141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To create a system for choosing surgical approach and completing laparotomy in advanced secondary peritonitis via combination of clinical, visual intra-abdominal criteria and systems for predicting the outcomes of peritonitis. MATERIAL AND METHODS The study included 686 patients with peritonitis between May 2015 and December 2022. Age of patients ranged from 16 to 95 years (mean 53.4±8.7). Male-to-female ratio was 1.2:11 (377:309). Destructive appendicitis was the cause of peritonitis in 274 (39.9%) patients, gastroduodenal ulcer perforation - 160 (23.3%) patients, colonic perforation - 188 (27.4%) patients, other causes - 64 (9.4%) patients. At baseline, 481 (70.1%) patients underwent diagnostic laparoscopy, and laparoscopic surgery was possible in 302 (62.8%) cases. Primary median laparotomy was performed in 205 (29.9%) patients. The closed method of completing laparotomy was used in 345 patients (77 - 22.3% died), staged elective surgeries - 28 (18 - 64.3% died), open abdomen technique was used in 11 patients (5 - 45.5% died). Redo laparotomy on demand was performed in 44 patients. Of these, 21 (47.7%) ones died. Overall mortality was 15.0% (n=103). The main causes of mortality were sepsis/septic shock (67 cases, 65.0%), acute cardiovascular and respiratory failure (15 patients, 14.6%). RESULTS The developed index of approach and completion of surgery in secondary peritonitis is valuable to make a decision on access and completion of surgery in patients with widespread peritonitis. CONCLUSION Integral systems for assessment of clinical status and choice of treatment strategy are effective in systematizing the results, evaluating treatment outcomes and conducting researches.
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Affiliation(s)
- N V Lebedev
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A E Klimov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - V S Shadrina
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A P Belyakov
- Peoples' Friendship University of Russia, Moscow, Russia
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Würstle S, Hapfelmeier A, Karapetyan S, Studen F, Isaakidou A, Schneider T, Schmid RM, von Delius S, Gundling F, Triebelhorn J, Burgkart R, Obermeier A, Mayr U, Heller S, Rasch S, Lahmer T, Geisler F, Chan B, Turner PE, Rothe K, Spinner CD, Schneider J. A Novel Machine Learning-Based Point-Score Model as a Non-Invasive Decision-Making Tool for Identifying Infected Ascites in Patients with Hydropic Decompensated Liver Cirrhosis: A Retrospective Multicentre Study. Antibiotics (Basel) 2022; 11:antibiotics11111610. [PMID: 36421254 PMCID: PMC9686825 DOI: 10.3390/antibiotics11111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study is aimed at assessing the distinctive features of patients with infected ascites and liver cirrhosis and developing a scoring system to allow for the accurate identification of patients not requiring abdominocentesis to rule out infected ascites. A total of 700 episodes of patients with decompensated liver cirrhosis undergoing abdominocentesis between 2006 and 2020 were included. Overall, 34 clinical, drug, and laboratory features were evaluated using machine learning to identify key differentiation criteria and integrate them into a point-score model. In total, 11 discriminatory features were selected using a Lasso regression model to establish a point-score model. Considering pre-test probabilities for infected ascites of 10%, 15%, and 25%, the negative and positive predictive values of the point-score model for infected ascites were 98.1%, 97.0%, 94.6% and 14.9%, 21.8%, and 34.5%, respectively. Besides the main model, a simplified model was generated, containing only features that are fast to collect, which revealed similar predictive values. Our point-score model appears to be a promising non-invasive approach to rule out infected ascites in clinical routine with high negative predictive values in patients with hydropic decompensated liver cirrhosis, but further external validation in a prospective study is needed.
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Affiliation(s)
- Silvia Würstle
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06520, USA
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, 81667 Munich, Germany
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Siranush Karapetyan
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Fabian Studen
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Andriana Isaakidou
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Tillman Schneider
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Roland M. Schmid
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Stefan von Delius
- Department of Internal Medicine II, RoMed Hospital Rosenheim, 83022 Rosenheim, Germany
| | - Felix Gundling
- Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Bogenhausen Hospital of the Munich Municipal Hospital Group, 81925 Munich, Germany
- Department of Internal Medicine II, Klinikum am Bruderwald, Sozialstiftung Bamberg, 96049 Bamberg, Germany
| | - Julian Triebelhorn
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Rainer Burgkart
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Andreas Obermeier
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Stephan Heller
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Benjamin Chan
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06520, USA
| | - Paul E. Turner
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06520, USA
- Program in Microbiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany
- Correspondence:
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Di Franco S, Alfieri A, Fiore M, Fittipaldi C, Pota V, Coppolino F, Sansone P, Pace MC, Passavanti MB. A Literature Overview of Secondary Peritonitis Due to Carbapenem-Resistant Enterobacterales (CRE) in Intensive Care Unit (ICU) Patients. Antibiotics (Basel) 2022; 11:antibiotics11101347. [PMID: 36290005 PMCID: PMC9598607 DOI: 10.3390/antibiotics11101347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
This comprehensive review of the recently published literature offers an overview of a very topical and complex healthcare problem: secondary peritonitis from multidrug-resistant pathogens, especially carbapenem-resistant Enterobacterales (CRE). Spontaneous secondary peritonitis and postsurgical secondary peritonitis are among the major causes of community- and healthcare- acquired sepsis, respectively. A large number of patients enter ICUs with a diagnosis of secondary peritonitis, and a high number of them reveal infection by CRE, P. aeruginosa or A. baumannii. For this reason, we conceived the idea to create a synthetic report on this topic including updated epidemiology data, a description of CRE resistance patterns, current strategies of antimicrobial treatment, and future perspectives. From this update it is clear that antimicrobial stewardship and precision medicine are becoming essential to fight the emergence of antimicrobial resistance and that even if there are new drugs effective against CRE causing secondary peritonitis, these drugs have to be used carefully especially in empirical therapy.
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Affiliation(s)
- Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Aniello Alfieri
- Department of Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio Cardarelli, Viale Antonio Cardarelli 9, 80131 Naples, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Ciro Fittipaldi
- Unit of Critical Care Hospital “Ospedale Pellegrini”, Via Portamedina alla Pignasecca 41, 80134 Naples, Italy
| | - Vincenzo Pota
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-081-566-5180
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10
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Ojo AB, Omoareghan Irabor D. Bacterial and Antibiotic Sensitivity Pattern in Secondary Peritonitis. J West Afr Coll Surg 2022; 12:82-87. [PMID: 36590769 PMCID: PMC9802587 DOI: 10.4103/jwas.jwas_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 01/03/2023]
Abstract
Background Peritonitis is inflammation of the peritoneum usually as a result of a localized or generalized infection. Secondary peritonitis which is the most common type follows an infective process in a visceral organ. The role of peritoneal cultures and use of antibiotics effective against culture results remain controversial. Objectives This study was conducted to determine the bacterial and antibiotic sensitivity pattern in patients with secondary peritonitis. It also compared the use of empirical antibiotics and culture-sensitive antibiotics with outcomes of patients with secondary peritonitis. Materials and Methods A prospective randomized clinical study was conducted. Five millilitres of peritoneal fluid was sampled intra-operatively, and microscopy, culture, and sensitivity testing was performed in patients with secondary peritonitis. The patients, randomized into two groups, had antibiotics administered for 7 days. The first group had empirical antibiotics throughout (Ceftriaxone + Metronidazole), whereas the second group had empirical antibiotics (Ceftriaxone + Metronidazole) for the first 2 days and antibiotics according to the sensitivity report for the remaining 5 days. The post-hoc analysis was also done on a third group, who, even though were randomized to either groups, had no growth on culture of peritoneal fluid. Results The commonest pathogens identified from the peritoneal culture of the participants were Escherichia coli, Klebsiella pneumonia, Anaerococcus group, and Bacteroides fragilis. Complications including mortality were significantly higher in those who received empirical antibiotics than those who received culture-sensitive antibiotics. Conclusion The outcome of antibiotics administration in patients with secondary peritonitis with a positive culture was better in those who received culture-sensitive antibiotics than those who received empirical antibiotics.
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11
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Markosyan SA, Vlasov AP, Charyshkin SA. [Antibacterial therapy for secondary peritonitis at different ages]. Khirurgiia (Mosk) 2022:85-91. [PMID: 36469473 DOI: 10.17116/hirurgia202212185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The review is devoted to antibiotic therapy for secondary community-acquired and postoperative peritonitis in children and adults. The authors analyze the features of pathogenic microflora in secondary peritonitis at different ages, sensitivity of microorganisms to various antibacterial drugs. Particular emphasis is placed on the choice of antimicrobial drugs and various antibiotic regimens, especially when initial empiric treatment is prescribed.
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Affiliation(s)
- S A Markosyan
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - A P Vlasov
- Ogarev National Research Mordovia State University, Saransk, Russia
| | - S A Charyshkin
- Ogarev National Research Mordovia State University, Saransk, Russia
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12
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Abstract
Introduction: Bacterial peritonitis is an infection with high mortality if not treated immediately. In the absence of an intraabdominal source of infection, bacterial peritonitis may arise in patients with liver cirrhosis, in patients on peritoneal dialysis (PD) for end-stage renal disease or in patients with tuberculosis. In patients with cirrhosis, bacterial peritonitis may trigger acute on chronic liver failure with substantial mortality despite optimal treatment. In patients on PD, peritonitis may make continuation of PD impossible, necessitating the switch to hemodialysis.Areas covered: Recovery from peritonitis and prevention of complications depend on timely pharmacological management. Challenges are the broad microbiological spectrum with growing rates of antimicrobial resistance, the underlying chronic liver or kidney failure and high rates of relapse. The authors provide a review of predisposing conditions, diagnosis, and prevention of bacterial peritonitis with a particular focus on the pharmacological management.Expert opinion: Diagnosis of the type of bacterial peritonitis is essential to pharmacological management. In patients with spontaneous bacterial peritonitis, broad-spectrum antibiotics should be given intravenously in conjunction with albumin. In patients on PD, antibiotic therapy should be preferably applied intraperitoneally with empirical coverage of gram-positive and gram-negative bacteria. Secondary peritonitis usually requires surgical or interventional treatment.
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Affiliation(s)
- Daniel Pörner
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Sibylle Von Vietinghoff
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- German Center for Infection Research (DZIF), University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- German Center for Infection Research (DZIF), University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- German Center for Infection Research (DZIF), University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
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13
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Garbez N, Mbatchi L, Wallis SC, Muller L, Lipman J, Roberts JA, Lefrant JY, Roger C. Prospective Cohort Study of Micafungin Population Pharmacokinetic Analysis in Plasma and Peritoneal Fluid in Septic Patients with Intra-abdominal Infections. Antimicrob Agents Chemother 2021; 65:e0230720. [PMID: 33846133 DOI: 10.1128/AAC.02307-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to describe the pharmacokinetics (PK) of micafungin in plasma and peritoneal fluid in septic patients with intra-abdominal infections. Twelve patients with secondary peritonitis in septic shock receiving 100 mg micafungin once daily were included. Total micafungin plasma and peritoneal fluid were subjected to a population pharmacokinetic analysis using Pmetrics. Monte Carlo simulations were performed considering the total area under the curve from 0 to 24 h (AUC0-24)/MIC ratios in plasma. Micafungin concentrations in both plasma and the peritoneal exudate were best described by a three-compartmental PK model with the fat-free mass (FFM) as a covariate of clearance (CL) and the volume of the central compartment (Vc). The mean parameter estimates (standard deviations [SD]) were 1.18 (0.40) liters/h for CL and 12.85 (4.78) liters for Vc. The mean peritoneal exudate/plasma ratios (SD) of micafungin were 25% (5%) on day 1 and 40% (8%) between days 3 and 5. Dosing simulations supported the use of standard 100-mg daily dosing for Candida albicans (FFM, <60 kg), C. glabrata (FFM, <50 kg), and C. tropicalis (FFM, <30 kg) on the second day of therapy. There is a moderate penetration of micafungin into the peritoneal cavity (25 to 40%). For empirical treatment, a dose escalation of at least a loading dose of 150 mg depending on the FFM of patients and the Candida species is suggested to be effective from the first day of therapy.
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Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg 2021; 110:139-149. [PMID: 33406974 DOI: 10.1177/1457496920984078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Secondary peritonitis and intra-abdominal sepsis are a global health problem. The life-threatening systemic insult that results from intra-abdominal sepsis has been extensively studied and remains somewhat poorly understood. While local surgical therapy for perforation of the abdominal viscera is an age-old therapy, systemic therapies to control the subsequent systemic inflammatory response are scarce. Advancements in critical care have led to improved outcomes in secondary peritonitis. The understanding of the effect of secondary peritonitis on the human microbiome is an evolving field and has yielded potential therapeutic targets. This review of secondary peritonitis discusses the history, classification, pathophysiology, diagnosis, treatment, and future directions of the management of secondary peritonitis. Ongoing clinical studies in the treatment of secondary peritonitis and the open abdomen are discussed.
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Affiliation(s)
- T W Clements
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Tolonen
- HUS Helsinki University Hospital, Helsinki, Finland
| | - C G Ball
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A W Kirkpatrick
- Foothills Medical Centre, Department of Critical Care Medicine and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Canadian Forces Medical Services, University of Calgary, Calgary, AB, Canada
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15
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Nema S, Brahmachari S. Pyonephrosis by Prevotella disiens and Escherichia coli coinfection and secondary peritonitis in an obstructive uropathy patient: A case report and review of the literature. J Family Med Prim Care 2020; 9:1263-1265. [PMID: 32318511 PMCID: PMC7113972 DOI: 10.4103/jfmpc.jfmpc_907_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
Pyonephrosis is an uncommon condition that is associated with suppurative destruction of the renal parenchyma. Upper urinary tract obstruction by renal stones plays an important role in its aetiology. The majority of pyonephrosis is reported to be caused by aerobic bacteria but the role of anaerobes, especially black-pigmented gram-negative anaerobes, namely, Prevotella and Porphyromonas in renal infections, remain poorly defined. In view of the rarity of the event, a case of pyonephrosis by Prevotella disiens and Escherichia coli coinfection complicated by secondary peritonitis in an obstructive uropathy patient is hereby presented. An attempt is being made to review the literature on the infective aetiologies of renal abscess with special reference to anaerobes.
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Affiliation(s)
- Shashwati Nema
- Department of Microbiology, AIIMS Bhopal, Madhya Pradesh, India
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16
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Batyrshin IM, Shlyapnikov SA, Demko AE, Ostroumova YS, Sklizkov DS, Fomin DV, Tishkov AV, Strakh LV. [Prediction and differentiated approach in the treatment of patients with secondary peritonitis and abdominal sepsis]. Khirurgiia (Mosk) 2020:27-33. [PMID: 32500686 DOI: 10.17116/hirurgia202005127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.
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Affiliation(s)
- I M Batyrshin
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - S A Shlyapnikov
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - A E Demko
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - Yu S Ostroumova
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - D S Sklizkov
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - D V Fomin
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - A V Tishkov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - L V Strakh
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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17
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Guilbart M, Zogheib E, Ntouba A, Rebibo L, Régimbeau JM, Mahjoub Y, Dupont H. Compliance with an empirical antimicrobial protocol improves the outcome of complicated intra-abdominal infections: a prospective observational study. Br J Anaesth 2018; 117:66-72. [PMID: 27317705 DOI: 10.1093/bja/aew117] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Despite improvements in medical and surgical care, mortality attributed to complicated intra-abdominal infections (cIAI) remains high. Appropriate initial antimicrobial therapy (ABT) is key to successful management. The main causes of non-compliance with empirical protocols have not been clearly described. METHODS An empirical ABT protocol was designed according to guidelines, validated in the institution and widely disseminated. All patients with cIAI (2009-2011) were then prospectively studied to evaluate compliance with this protocol and its impact on outcome. Patients were classified into two groups according to whether or not they received ABT in compliance with the protocol. RESULTS 310 patients were included: 223 (71.9%) with community-acquired and 87 (28.1%) with healthcare-associated cIAI [mean age 60(17-97) yr, mean SAPS II score 24(16)]. Empirical ABT complied with the protocol in 52.3% of patients. The appropriateness of empirical ABT to target the bacteria isolated was 80%. Independent factors associated with non-compliance with the protocol were the anaesthetist's age ≥36 yr [OR 2.1; 95%CI (1.3-3.4)] and the presence of risk factors for multidrug-resistant bacteria (MDRB) [OR 5.4; 95%CI (3.0-9.5)]. Non-compliance with the protocol was associated with higher mortality (14.9 vs 5.6%, P=0.011) and morbidity: relaparotomy (P=0.047), haemodynamic failure (P=0.001), postoperative pneumonia (P=0.025), longer duration of mechanical ventilation (P<0.001), longer ICU stay (P<0.001) and longer hospital stay (P=0.002). On multivariate logistic regression analysis, non-compliance with the ABT protocol was independently associated with mortality [OR 2.4; 95% CI (1.1-5.7), P=0.04]. CONCLUSIONS Non-compliance with empirical ABT guidelines in cIAI is associated with increased morbidity and mortality. Information campaigns should target older anaesthetists and risk factors for MDRB.
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Affiliation(s)
- M Guilbart
- Department of Anaesthesiology and Critical Medicine
| | - E Zogheib
- Department of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France
| | - A Ntouba
- Department of Anaesthesiology and Critical Medicine
| | - L Rebibo
- Department of Digestive and Metabolic Surgery, Amiens University Hospital, Amiens, France
| | - J M Régimbeau
- Department of Digestive and Metabolic Surgery, Amiens University Hospital, Amiens, France
| | - Y Mahjoub
- Department of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France
| | - H Dupont
- Department of Anaesthesiology and Critical Medicine INSERM UMR 1088, Jules Verne University Picardy, Amiens, France
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18
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Almuzara M, Cittadini R, Estraviz ML, Ellis A, Vay C. First report of Comamonas kerstersii causing urinary tract infection. New Microbes New Infect 2018; 24:4-7. [PMID: 29922468 PMCID: PMC6004729 DOI: 10.1016/j.nmni.2018.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/03/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022] Open
Abstract
The association of Comamonas kerstersii with peritonitis resulting from perforated appendix and its isolation from a psoas abscess and pelvic peritonitis have previously been described by us. We present the first case of C. kerstersii urinary tract infection, broadening the spectrum of infections caused by this species.
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Affiliation(s)
- M Almuzara
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Argentina
| | - R Cittadini
- Sanatorio Mater Dei, Ciudad Autónoma de Buenos Aires, Argentina
| | - M L Estraviz
- Sanatorio Mater Dei, Ciudad Autónoma de Buenos Aires, Argentina
| | - A Ellis
- Sanatorio Mater Dei, Ciudad Autónoma de Buenos Aires, Argentina
| | - C Vay
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Argentina.,Sanatorio Mater Dei, Ciudad Autónoma de Buenos Aires, Argentina
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19
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Milić L, Grigorov I, Krstić S, Ćeranić MS, Jovanović B, Stevanović J, Peško P. Serum Level of HMGB1 Protein and Inflammatory Markers in Patients with Secondary Peritonitis: Time Course and the Association with Clinical Status. J Med Biochem 2017; 36:44-53. [PMID: 28680349 PMCID: PMC5471659 DOI: 10.1515/jomb-2016-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023] Open
Abstract
Background Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis.
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Affiliation(s)
- Ljiljana Milić
- Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ilijana Grigorov
- Department of Molecular Biology, Institute for Biological Research, Belgrade, Serbia
| | - Slobodan Krstić
- Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Miljan S Ćeranić
- Clinic for Digestive Surgery, University Clinical Center of Belgrade, School of Medicine, University of Belgrade, Serbia
| | - Bojan Jovanović
- Center for Anesthesiology, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Jelena Stevanović
- Department of Molecular Biology, Institute for Biological Research, Belgrade, Serbia
| | - Predrag Peško
- Clinic for Digestive Surgery, University Clinical Center of Belgrade, School of Medicine, University of Belgrade, Serbia
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20
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Atema JJ, Ram K, Schultz MJ, Boermeester MA. External Validation of a Decision Tool To Guide Post-Operative Management of Patients with Secondary Peritonitis. Surg Infect (Larchmt) 2016; 18:189-195. [PMID: 27991844 DOI: 10.1089/sur.2016.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Timely identification of patients in need of an intervention for abdominal sepsis after initial surgical management of secondary peritonitis is vital but complex. The aim of this study was to validate a decision tool for this purpose and to evaluate its potential to guide post-operative management. METHODS A prospective cohort study was conducted on consecutive adult patients undergoing surgery for secondary peritonitis in a single hospital. Assessments using the decision tool, based on one intra-operative and five post-operative variables, were performed on the second and third post-operative days and when the patients' clinical status deteriorated. Scores were compared with the clinical reference standard of persistent sepsis based on the clinical course or findings at imaging or surgery. Additionally, the potential of the decision tool to guide management in terms of diagnostic imaging in three previously defined score categories (low, intermediate, and high) was evaluated. RESULTS A total of 161 assessments were performed in 69 patients. The majority of cases of secondary peritonitis (68%) were caused by perforation of the gastrointestinal tract. Post-operative persistent sepsis occurred in 28 patients. The discriminative capacity of the decision tool score was fair (area under the curve of the receiver operating characteristic = 0.79). The incidence rate differed significantly between the three score categories (p < 0.001). The negative predictive value of a decision tool score categorized as low probability was 89% (95% confidence interval [CI] 82-94) and 65% (95% CI 47-79) for an intermediate score. Diagnostic imaging was performed more frequently when there was an intermediate score than when the score was categorized as low (46% vs. 24%; p < 0.001). CONCLUSION In patients operated on for secondary peritonitis, the decision tool score predicts with fair accuracy whether persistent sepsis is present.
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Affiliation(s)
- Jasper J Atema
- 1 Department of Surgery, Academic Medical Centre , Amsterdam, The Netherlands
| | - Kim Ram
- 1 Department of Surgery, Academic Medical Centre , Amsterdam, The Netherlands
| | - Marcus J Schultz
- 2 Department of Intensive Care, Academic Medical Centre , Amsterdam, The Netherlands
| | - Marja A Boermeester
- 1 Department of Surgery, Academic Medical Centre , Amsterdam, The Netherlands
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21
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Doklestić SK, Bajec DD, Djukić RV, Bumbaširević V, Detanac AD, Detanac SD, Bracanović M, Karamarković RA. Secondary peritonitis - evaluation of 204 cases and literature review. J Med Life 2014; 7:132-8. [PMID: 25408716 PMCID: PMC4197493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/17/2014] [Indexed: 11/03/2022] Open
Abstract
HYPOTHESIS Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity. OBJECTIVE This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis. METHODS AND RESULTS The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; p<0,001). The overall mortality rate in our study was 8,82%. The mortality rate was significantly the highest among the patients with mesenteric ischemia in 4 patients (66,67%), followed by colon perforation in 10 cases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; p<0,001). DISCUSSION This study has confirmed that the clinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections.
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Affiliation(s)
- SK Doklestić
- Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - DD Bajec
- School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery,
Clinical Center of Serbia, Belgrade, Serbia
| | - RV Djukić
- School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery,
Clinical Center of Serbia, Belgrade, Serbia
| | - V Bumbaširević
- School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Anesthesiology, Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - M Bracanović
- Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - RA Karamarković
- School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Emergency Surgery,
Clinical Center of Serbia, Belgrade, Serbia
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