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Management and outcome of high-risk peritonitis: a retrospective survey 2005-2009
Caroline Theunissen1, Soraya Cherifi, Rafik Karmali
1Infection Control Unit, Brugmann University Hospital, Brussels, Belgium. caroline.theunissen@chu-brugmann.be
Objectives:
To describe the clinical and microbiological aspects of high-risk peritonitis and to analyze their impact on its outcome.
Methods:
This was a retrospective review of all culture-positive peritonitis between October 1, 2005 and September 30, 2009. In accordance with recent Infectious Diseases Society of America (IDSA) guidelines, a group of high-risk peritonitis patients was selected based on age, severity of illness, underlying diseases, and acquisition of the infection.
Results:
Ninety-three patients with high-risk peritonitis were studied; these patients were divided into subgroups of those with community-associated disease (14%) and those with healthcare-associated disease (86%). The median age of patients was 66 (interquartile range (IQR) 22-95) years. The 30-day mortality rate was 25%. Subgroups differed in age (p=0.011), degree of comorbidity (p=0.023), severity of peritonitis (p=0.036), admission to the intensive care unit (ICU) (p=0.002), length of ICU stay (p<0.001), length of hospital stay (p<0.001), cure at day 30 (p=0.001), and adequate treatment (p=0.042). The microbiological etiology and resistance profiles were similar between the patient groups. Adequate empirical treatment was not related to a better outcome. Severity of disease (p=0.005) and the presence of enterococci (p=0.044) were independently associated with mortality.
Conclusions:
The mode of acquisition influences severity and certain parameters of outcome in high-risk peritonitis, but not its microbiological etiology. The outcome seems to depend primarily on severity of peritonitis and much less on the adequacy of treatment.
Insights
High-risk peritonitis outcomes are influenced by how the infection was acquired, not its specific cause. Patient survival depends more on peritonitis severity than on treatment adequacy.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Microbiology
Background:
- Peritonitis, particularly high-risk cases, presents significant clinical challenges.
- Understanding factors influencing peritonitis outcomes is crucial for patient management.
Purpose of the Study:
- To delineate clinical and microbiological features of high-risk peritonitis.
- To assess the impact of these factors on patient outcomes.
Main Methods:
- Retrospective review of culture-positive peritonitis cases (2005-2009).
- Patient selection based on Infectious Diseases Society of America (IDSA) guidelines for high-risk peritonitis.
- Analysis of community-associated versus healthcare-associated peritonitis subgroups.
Main Results:
- Healthcare-associated peritonitis was more common (86%) in the 93 studied patients.
- 30-day mortality rate was 25%, with higher mortality linked to disease severity and enterococcal infections.
- Acquisition mode impacted peritonitis severity and outcomes, but not microbiological etiology.
Conclusions:
- The origin of high-risk peritonitis (community vs. healthcare) affects severity and outcomes.
- Peritonitis severity is a primary determinant of outcome, outweighing treatment adequacy.
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