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Published on: September 21, 2019
Analysis of Bacterial Pathogens Causing Complicating HAP in Patients with Secondary Peritonitis
Josef Chudáček1, Petr Špička1, Milan Kolar2
1Department of Surgery I, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 976/3, 77515 Olomouc, Czech Republic.
Background:
Diffuse peritonitis is an acute abdominal condition characterized by high mortality. The main treatment modality is surgery, requiring a subsequent prolonged hospital stay. These patients are, among other things, at risk of developing hospital-acquired pneumonia (HAP), which considerably worsens their treatment outcomes. This study aimed to extend the existing knowledge by providing more detailed microbiological characteristics of complicating HAP in patients with secondary peritonitis, including the identification of isolated bacterial pathogens and their potential sources.
Methods:
The 2015-2019 retrospective study comprised all patients with an intraoperatively confirmed diagnosis of secondary diffuse peritonitis who were classified in accordance with the quick Sepsis Related Organ Failure Assessment scoring system.
Results:
HAP developed in 15% of patients. The 90-day mortality rates were 53% and 24% in patients with and without HAP; respectively. The most frequent pathogens responsible for HAP were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae complex and Enterococcus faecalis. Multidrug resistance to antibiotics was found in 38% of bacterial pathogens. Clonal spread of these bacterial pathogens among patients was not detected. Rather, the endogenous characteristic of HAP was confirmed.
Conclusions:
The initial antibiotic therapy of complicating HAP in patients with secondary peritonitis must be effective mainly against enterobacteria, including strains with the production of ESBL and AmpC beta-lactamases, Pseudomonas aeruginosa and Enterococcus faecalis. The study further highlighted the importance of monitoring the respiratory tract bacterial microflora in patients with secondary peritonitis. The results should be used for initial antibiotic treatment of complicating HAP instances.
Insights
Hospital-acquired pneumonia (HAP) in diffuse peritonitis patients significantly increases mortality. Initial antibiotic therapy should target common enterobacteria, Pseudomonas aeruginosa, and Enterococcus faecalis, considering multidrug resistance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Diffuse peritonitis is a severe condition with high mortality, often requiring surgery and leading to prolonged hospital stays.
- Patients with secondary peritonitis face a significant risk of developing hospital-acquired pneumonia (HAP), which negatively impacts treatment outcomes.
- Understanding the specific microbiological profiles of HAP in this vulnerable population is crucial for improving patient care.
Purpose of the Study:
- To detail the microbiological characteristics of hospital-acquired pneumonia (HAP) complicating secondary diffuse peritonitis.
- To identify common bacterial pathogens and their sources in HAP cases within this patient group.
- To inform targeted antibiotic strategies for HAP in patients with secondary peritonitis.
Main Methods:
- A retrospective study analyzed data from 2015-2019.
- Included patients with intraoperatively confirmed secondary diffuse peritonitis.
- Patients were classified using the quick Sepsis Related Organ Failure Assessment (qSOFA) scoring system.
Main Results:
- Hospital-acquired pneumonia (HAP) occurred in 15% of patients, with 90-day mortality rates of 53% (HAP) vs. 24% (no HAP).
- Predominant pathogens included Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae complex, and Enterococcus faecalis.
- Multidrug resistance was observed in 38% of pathogens; HAP was confirmed to be endogenous, not due to clonal spread.
Conclusions:
- Initial antibiotic treatment for HAP in secondary peritonitis should cover enterobacteria (including ESBL/AmpC producers), Pseudomonas aeruginosa, and Enterococcus faecalis.
- Monitoring respiratory tract bacterial microflora in patients with secondary peritonitis is essential.
- Study findings provide a basis for optimizing initial antibiotic regimens for HAP in this patient cohort.
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