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Microbial findings, sensitivity and outcome in patients with postoperative peritonitis a retrospective cohort study
Rainer Grotelueschen1, Marc Luetgehetmann2, Johannes Erbes1
1Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
Background:
Acute postoperative peritonitis resulting from previous abdominal surgery is still a severe and potentially fatal disease, which is associated with high morbidity and mortality. The aim of the present study was to evaluate patients' outcome after postoperative peritonitis and identify the most effective empiric antibiotic regimes.
Methods:
422 patients with acute postoperative peritonitis as a result to earlier abdominal operation (e.g. anastomotic leakage) were analyzed retrospectively focusing on the origin of the peritonitis, microbial flora and resistance patterns. Furthermore, mortality was estimated according to sensitivity results of the tested antibiotics.
Results:
In 50% of the patients, anastomotic leakage was located in the colon. The predominantly cultured microorganisms were Escherichia coli and Enterobacteriaceae. The combination of meropenem and vancomycin was effective in 96% of these microbes. The frequently used combinations of piperacillin/sulbactam and cefotaxime/metronidazole were effective in only 67% and 43%, respectively.
Conclusions:
We were able to show that the currently used antibiotic regimes with piperacillin/sulbactam and cefotaxime/metronidazole are ineffective in a relevant number of patients with anastomotic leakage. Only meropenem or meropenem/vancomycin cover most of the microbes predominant in postoperative peritonitis.
Insights
Meropenem or meropenem/vancomycin effectively treat postoperative peritonitis, unlike piperacillin/sulbactam and cefotaxime/metronidazole, which show reduced efficacy against common microbes like Escherichia coli and Enterobacteriaceae.
Area of Science:
- Surgical infections
- Infectious diseases
- Pharmacology
Background:
- Acute postoperative peritonitis is a severe complication of abdominal surgery with high morbidity and mortality.
- Anastomotic leakage is a common cause of postoperative peritonitis.
Purpose of the Study:
- To evaluate patient outcomes after postoperative peritonitis.
- To identify the most effective empiric antibiotic regimens for treating postoperative peritonitis.
Main Methods:
- Retrospective analysis of 422 patients with postoperative peritonitis.
- Investigation of peritonitis origin, microbial flora, and antibiotic resistance patterns.
- Mortality estimation based on antibiotic sensitivity results.
Main Results:
- Anastomotic leakage in the colon was observed in 50% of patients.
- Escherichia coli and Enterobacteriaceae were the predominant microorganisms.
- Meropenem/vancomycin demonstrated 96% effectiveness, while piperacillin/sulbactam and cefotaxime/metronidazole showed 67% and 43% effectiveness, respectively.
Conclusions:
- Current antibiotic regimens (piperacillin/sulbactam, cefotaxime/metronidazole) are often ineffective for anastomotic leakage-related peritonitis.
- Meropenem or meropenem/vancomycin are recommended for empiric treatment due to broad coverage of predominant microbes.
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