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Relevance and utility of peritoneal cultures in patients with peritonitis
1Department of Surgery, University of Washington, and Division of General and Trauma Surgery, Harborview Medical Center, Seattle, Washington 98104, USA. anathens@u.washington.edu
Background:
The pathogenic organisms responsible for the manifestations of secondary peritonitis have been well characterized through almost 30 years of experimental and clinical studies. Enteric gram-negative organisms and anaerobes predominate, with Escherichia coli and Bacteroides fragilis, respectively, being the most frequent isolates. This flora is remarkably consistent across patients and institutions. As a result of this consistency and the availability of well-established effective empiric antimicrobial regimens, many surgeons believe that cultures of peritoneal exudates in patients with peritonitis offer no useful information and no clinical benefit.
Methods:
Review of pertinent antibiotic and management trials in the management of intraabdominal infection.
Results:
There is increasing evidence that identification of organisms resistant to the chosen empiric antibiotic regimen portends a higher likelihood of failure. What is not clear is whether postoperative changes in the regimen in accordance with sensitivity patterns of the isolates offers any clinical advantage. In most circumstances, the data provided allow for simplification of the antibiotic regimen.
Conclusion:
The potential for reducing antibiotic exposure and the value of information derived from surveillance of microbial sensitivity patterns support the routine performance of peritoneal cultures.
Insights
Peritoneal cultures in secondary peritonitis cases help identify resistant organisms, guiding treatment. Routine cultures offer value by potentially reducing antibiotic exposure and improving patient outcomes.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Infections
Background:
- Secondary peritonitis is commonly caused by enteric Gram-negative organisms and anaerobes, notably Escherichia coli and Bacteroides fragilis.
- The microbial flora in peritonitis is consistent across patients and institutions.
- Effective empiric antibiotic regimens are available, leading some surgeons to question the utility of peritoneal cultures.
Purpose of the Study:
- To evaluate the clinical utility and benefit of performing peritoneal cultures in patients with secondary peritonitis.
- To assess the impact of microbial identification and sensitivity patterns on treatment regimens and patient outcomes.
Main Methods:
- A review of antibiotic and management trials related to intra-abdominal infections was conducted.
- Analysis focused on the role of microbial surveillance in guiding therapeutic decisions.
Main Results:
- Identification of organisms resistant to empiric antibiotics correlates with a higher likelihood of treatment failure.
- Postoperative regimen adjustments based on isolate sensitivity may offer clinical advantages.
- Data often support simplifying antibiotic regimens based on culture results.
Conclusions:
- Routine performance of peritoneal cultures is supported by the potential to reduce antibiotic exposure.
- Surveillance of microbial sensitivity patterns provides valuable information for patient management.
- Peritoneal cultures contribute to optimizing treatment strategies and potentially improving outcomes in secondary peritonitis.