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Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis
Philippe Montravers1, Guillaume Dufour2, Jean Guglielminotti3
1Département d'Anesthésie Réanimation, Université Paris Diderot, APHP, CHU Bichat-Claude Bernard, 46, Rue Henri Huchard, Paris, 75018, France. philippe.montravers@bch.aphp.fr.
Critical Care (London, England)
|April 19, 2015
Summary
Persistent peritonitis leads to more multidrug-resistant (MDR) strains with each reoperation. Timely source control, not antibiotics, is key to preventing MDR bacteria emergence in these critical cases.
Area of Science:
- Intensive Care Medicine
- Surgical Infections
- Microbiology
Background:
- Persistent peritonitis is a common, severe complication of secondary peritonitis.
- It often necessitates repeated surgeries and antibiotic treatments, raising concerns about multidrug-resistant (MDR) strains.
- The dynamics of MDR strain emergence in persistent peritonitis require further investigation.
Purpose of the Study:
- To compare clinical, microbiological, and therapeutic data between patients with and without persistent peritonitis.
- To analyze the emergence and dynamics of MDR strains in patients undergoing reoperations for persistent peritonitis.
- To identify risk factors associated with the emergence of MDR strains.
Main Methods:
- A comparative study of ICU patients with postoperative peritonitis, divided into groups with and without reoperation.
- Analysis of clinical, microbiological, and therapeutic data from index surgery and subsequent reoperations.
- Multivariate analysis to assess risk factors for MDR strain emergence.
Main Results:
- Persistent peritonitis cases showed higher initial severity and fungal isolates.
- Septic shock was the primary clinical manifestation.
- MDR strains significantly increased with each reoperation, from 41% at index surgery to 76% by the third reoperation.
- Time to reoperation was the sole identified risk factor for MDR emergence.
Conclusions:
- Initial severity, Candida presence, and inadequate source control are key risk factors for persistent peritonitis.
- MDR bacteria emergence is frequent and escalates with the number of reoperations.
- Effective source control, rather than antibiotic regimens, is critical in managing MDR strain emergence.
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