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[Intra-abdominal infection and new quinolones]
1Departamento de Medicina, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Abstract:
Intra-abdominal infection is defined as the presence of an infectious process within the peritoneal cavity. It may be local or have a systemic consequence generating multiple organic disfunction. Most of the studies report a mortality of 30% in severe intra-abdominal infection. Secondary peritonitis is caused by the loss of integrity of the gastrointestinal apparatus, which contaminates with pathogens the peritoneal cavity. Invariably they are polymicrobial infections, mostly due to facultative anaerobic and anaerobic Gram negative bacilli. Prognosis of peritonitis depends on the struggle between two forces: local and systemic immunity of the host and the volume, nature and length of the contamination. Microorganisms and their products estimulate cellular defenses in the host and activate numerous inflammatory mediators responsible for sepsis. Antibiotic treatment of secondary peritonitis must act mainly against Escherichia coli and Bacteroides fragilis. The adequate and early empirical administration of antibiotics against these bacteria is well established. It is necessary to consider if the infection is localized or generalized and if it is accompanied or not by organic disfunction. It also has to be taken into account if peritonitis is community or hospital-acquired when choosing the antibiotic scheme. In community-acquired peritonitis with low to moderate infections a combination of metronidazole-ceftriaxone, metronidazole-gentamycin or a monodrug like ampicillin-sulbactam may be used. In severe hospital-acquired peritonitis imipenem or the combination piperacillin-tazobactam are effective. New quinolones such as trovafloxacin or clinafloxacin, with excellent activity against aerobes and anaerobes producing intra-abdominal infections, may be effective. Future clinical trials are needed to determine their utility. Tertiary peritonitis represent a systemic inflammatory response with multiorganic failure due to the uncontrolled activation of the inflammatory cascade. It is considered a persistent, systemic peritoneal inflammation. Antibiotics and new surgery do not seem to be useful in this situation.
Insights
Intra-abdominal infection, often severe, carries a high mortality. Effective antibiotic treatment for secondary peritonitis targets specific bacteria like Escherichia coli and Bacteroides fragilis.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgical Infections
Context:
- Intra-abdominal infection involves infectious processes within the peritoneal cavity, potentially leading to systemic dysfunction and high mortality rates.
- Secondary peritonitis arises from gastrointestinal tract integrity loss, causing polymicrobial contamination, primarily by Gram-negative bacilli.
- Prognosis hinges on host immunity versus contamination severity, with sepsis triggered by microbial products and inflammatory mediators.
Purpose:
- To outline the definition, causes, and prognosis of intra-abdominal infections, focusing on secondary peritonitis.
- To detail appropriate antibiotic strategies for secondary peritonitis based on infection severity and acquisition source (community vs. hospital-acquired).
- To differentiate secondary peritonitis from tertiary peritonitis, highlighting the latter's systemic inflammatory response and multiorganic failure.
Summary:
- Antibiotic therapy for secondary peritonitis must target Escherichia coli and Bacteroides fragilis, with empirical choices guided by infection localization, severity, and origin.
- Community-acquired peritonitis may be treated with combinations like metronidazole-ceftriaxone or ampicillin-sulbactam, while severe hospital-acquired cases warrant imipenem or piperacillin-tazobactam.
- Emerging quinolones show promise, but further clinical trials are necessary to establish their role in managing these complex infections.
Impact:
- Provides critical guidance for clinicians in selecting optimal empirical antibiotic regimens for secondary peritonitis.
- Highlights the importance of considering patient-specific factors and infection characteristics for improved treatment outcomes.
- Differentiates between treatable secondary peritonitis and the often intractable tertiary peritonitis, informing patient management and prognosis.