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Risk factors for multidrug-resistant bacteria in patients with post-operative peritonitis requiring intensive care

Philippe Seguin1, Yannick Fédun, Bruno Laviolle

  • 1Service de Réanimation Chirurgicale, Université Rennes 1, INSERM U991, Hôpital de Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, Rennes, France. philippe.seguin@chu-rennes.fr

The Journal of Antimicrobial Chemotherapy
|December 17, 2009
PubMed
Abstract

Insights

Prior antibiotic use and delayed surgery increase multidrug-resistant bacteria (MDRB) risk in post-operative peritonitis (POP) patients. Empirically broad-spectrum antibiotics are recommended for high-risk POP cases.

Area of Science:

  • Infectious Diseases
  • Surgical Critical Care
  • Antimicrobial Resistance

Background:

  • Post-operative peritonitis (POP) poses significant risks, including multidrug-resistant bacteria (MDRB) development.
  • Identifying risk factors for MDRB in POP is crucial for effective empirical antimicrobial therapy.

Purpose of the Study:

  • To investigate risk factors associated with MDRB in patients experiencing their first episode of POP.
  • To inform empirical antimicrobial treatment strategies for POP patients.

Main Methods:

  • Prospective, non-interventional study of 115 adult patients with POP in a surgical intensive care unit (ICU).
  • Inclusion criteria: age >15 years, first POP episode, ICU admission between September 2006 and January 2009.
  • Antibiotic susceptibility testing performed on blood and peritoneal fluid cultures using disc diffusion.

Main Results:

  • MDRB were identified in 17% (20/115) of POP patients.
  • Independent risk factors for MDRB included prior antimicrobial therapy (OR=5.80) and a delay >5 days between the first operation and relaparotomy (OR=1.10).
  • No MDRB were detected when the delay to relaparotomy was less than 5 days.

Conclusions:

  • Patients with POP who received antibiotics within 3 months prior to hospitalization are at higher risk for MDRB.
  • POP patients with a delay of over 5 days between the first operation and relaparotomy also face increased MDRB risk.
  • Broad-spectrum antibiotic use is recommended for ICU patients with POP exhibiting these risk factors.

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