[The assessment of empiric antibiotherapy in acute secondary peritonitis]

The adequate use of antibiotics, according to the international guidelines of antimicrobial therapy, is, in addition to surgery, an important part of the management of intra-abdominal infections. The aim of the study was to assess the efficacy of empiric antibiotherapy in acute peritonitis of digestive cause.

A retrospective study was carried out on a series of 75 cases of acute peritonitis, admitted in the IIIrd Surgical Unit, in the period 2003-2005. Perforated duodenal ulcer was the cause of diffuse peritonitis in 46 % of the cases, followed by acute appendicitis (31%) and traumatic perforation of the small bowel (11 %). The most frequent bacteria encountered was E. coli (62 %), while Klebsiella, Enterobacter and Acinetobacter were present in nearly 8% of the cases. Ertapenem as single agent was preferred in 36.8% of the patients and an association of third generation cephalosporins or aminoglycoside with metronidazole in 33.4%.

the efficiency of the treatment was assessed in regard to clinical (fever) and laboratory (leucocytosis) data, the duration of treatment and hospital stay. The outcome was appreciated as good in almost 73% of the patients treated with ertapenem, and 52% respectively for combined therapy.

the authors recommend the use of penems as monotherapy in the empiric treatment of acute peritonitis following digestive perforation.