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Published on: February 20, 2020
Pseudomonas aeruginosa post-operative peritonitis: clinical features, risk factors, and prognosis
Pascal Augustin1, Alexy Tran-Dinh, Nadia Valin
1Department of Anesthesiology and Intensive Care, University of Paris Diderot, Sorbonne Paris Cité and APHP, Hôpital Bichat-Claude Bernard, Paris, France. pascalaugustin@hotmail.com
Background:
Postoperative peritonitis (PP) is associated with a high rate of multi-drug-resistant micro-organisms. The role of Pseudomonas aeruginosa in this condition has never been assessed. We evaluated the risk factors and prognosis for PP caused by P. aeruginosa.
Methods:
Patients hospitalized in the intensive care unit (ICU) after re-operation for PP were identified prospectively. Analyses were performed retrospectively. Specific risk factors were investigated by comparing P. aeruginosa PP with PP having other causes. The main outcome endpoint was death in the hospital.
Results:
We found 55 P. aeruginosa PP among the 349 cases of PP (16%) in the ICU over 14 years. Factors associated with the presence of P. aeruginosa in peritoneal fluid culture were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.02-1.09; p=0.004) and respiratory failure (OR 2.3; 95% CI 1.26-4.16; p=0.006). These criteria performed poorly in predicting P. aeruginosa PP. Such infections were associated with a higher hospital mortality rate, but not after adjustment for the severity score. Adequate antibiotic therapy comprising two antibiotics effective against P. aeruginosa was associated with a lower mortality rate for P. aeruginosa PP in the ICU.
Conclusion:
The prevalence of P. aeruginosa PP is not high. Risk factors do not allow accurate prediction of the infection. Our data suggest two drugs effective against P. aeruginosa should be considered for treating these infections.
Insights
Pseudomonas aeruginosa postoperative peritonitis (PP) is not common, and risk factors poorly predict it. Effective dual-antibiotic therapy is linked to lower mortality in these intensive care unit (ICU) infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Surgical Infections
Background:
- Postoperative peritonitis (PP) often involves multi-drug-resistant organisms.
- The specific role of Pseudomonas aeruginosa in PP was previously unevaluated.
Purpose of the Study:
- To assess risk factors and prognosis for PP caused by P. aeruginosa.
- To determine the prevalence of P. aeruginosa in PP cases.
Main Methods:
- Prospective identification of intensive care unit (ICU) patients re-operated for PP.
- Retrospective analysis of risk factors and outcomes.
- Comparison of P. aeruginosa PP with other PP etiologies.
Main Results:
- P. aeruginosa accounted for 16% of PP cases in the ICU over 14 years.
- High APACHE II score and respiratory failure were associated with P. aeruginosa, but predictive value was poor.
- P. aeruginosa PP had higher mortality, but this was not significant after adjusting for severity. Adequate dual-antibiotic therapy improved survival.
Conclusions:
- P. aeruginosa PP is not highly prevalent.
- Accurate prediction of P. aeruginosa PP using identified risk factors is not feasible.
- Treatment with two effective antibiotics against P. aeruginosa is recommended for P. aeruginosa PP.
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