Management of secondary peritonitis: our experience

Intra-abdominal infections are a common cause of nosocomial sepsis and are associated with a severe morbility, mortality and sanitary economy implications, especially for decentrated sanitary structures. Mortality due to diffuse suppurative peritonitis (fom 10 to 20%) nowadays continues to be unacceptably high. Patients outcome is significantly influenced by early adequate surgery and/or peritoneal drainage: moreover, even early and adequate empiric antimicrobial therapy influences patients morbidity and mortality. Multiple empirical regimens have been proposed, but rarely supported by reliable randomized-controlled studies. The authors report 201 cases of patients with fever and meaningful peritoneal involvement occurred since August 1999 up to August 2005: 110 cases were conservatively treated, 91 cases were surgically treated. The paper summarizes IDAB (Infection Disease Advisory Board) guidelines inheriting management of intra-abdominal infections: empiric antimicrobial therapy for the most common causes of abdominal infections is proposed for low-mid level risk patients, focusing on antibiotic treatment duration. High risk patients need to be evaluated paying particular attention to timely surgical infection source control.

Despite of the progress in antimicrobial agents and intensive care treatment, peritonitis is still one of the most important infectious problems that a surgeon has to face.