Related Experiment Videos
Microbiologic features and treatment of persistent peritonitis in patients in the intensive care unit
Abstract:
The charts of 25 patients who died in the intensive care unit of persistent peritonitis after abdominal operations were reviewed to determine the microbial flora and the efficacy of antibiotic treatment. All patients had undergone two or more surgical procedures for abdominal sepsis and 23 had at least three-system organ failure. The most common organisms cultured were: Staphylococcus epidermidis, 24 cultures from 16 patients, Candida albicans, 19 cultures from 10 patients, Pseudomonas aeruginosa, 16 cultures from 12 patients, Enterobacter, 16 cultures from 8 patients and enterococcus, 14 cultures from 8 patients. The classic isolates, Escherichia coli (11 cultures from six patients) and Bacteroides fragilis (4 cultures from three patients) were found infrequently. To determine the adequacy of antimicrobial therapy for this "new" flora, we examined the ability of appropriate agents to eradicate the micro-organism upon subsequent culture. Candida sp. were eradicated in 54% (6 of 11) of the assessable cases, while enterococcus and S. epidermidis were cleared in only 25% and 28% respectively. The spectrum of intra-abdominal organisms cultured from critically ill surgical patients in the intensive care unit differs from that seen in those with acute peritonitis. Despite administration of appropriate antimicrobial agents, these organisms tend to persist, probably reflecting impaired host defences with multiple-system organ failure rather than antimicrobial failure.
Insights
Persistent peritonitis in intensive care unit (ICU) patients shows a shift in common microbial flora. Antibiotic treatment efficacy is limited against prevalent organisms like Staphylococcus epidermidis and enterococcus.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Surgical Infections
Background:
- Persistent peritonitis is a significant cause of mortality in intensive care unit (ICU) patients following abdominal operations.
- Patients often undergo multiple surgical procedures for abdominal sepsis and frequently present with multi-system organ failure.
Purpose of the Study:
- To investigate the microbial flora in critically ill patients with persistent peritonitis.
- To evaluate the efficacy of antibiotic treatment against the identified microbial spectrum.
Main Methods:
- Retrospective chart review of 25 deceased ICU patients with persistent peritonitis.
- Analysis of microbial cultures to identify common organisms.
- Assessment of antimicrobial therapy success in eradicating identified pathogens.
Main Results:
- Commonly cultured organisms included Staphylococcus epidermidis, Candida albicans, Pseudomonas aeruginosa, Enterobacter, and enterococcus.
- Traditional pathogens like Escherichia coli and Bacteroides fragilis were less frequent.
- Antimicrobial eradication rates were low for enterococcus (25%) and S. epidermidis (28%), but higher for Candida sp. (54%).
Conclusions:
- The microbial flora in persistent peritonitis differs from acute peritonitis, with a rise in less common pathogens.
- Persistence of these organisms suggests impaired host defenses in critically ill patients with multi-system organ failure, rather than solely antimicrobial failure.