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Published on: December 18, 2010
Clinical Outcomes and Microbiological Profiles of Patients with Culture-Confirmed Peritonitis
Yusuf Emre Özdemir1, Esra Ensaroğlu1, Samiha Akkaya1
1Department of Infectious Diseases and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training Research Hospital, İstanbul, Türkiye.
Objective:
This study aimed to identify pathogenic microorganisms and resistance profiles, clinical outcomes, and mortality-related risk factors in patients with culture-confirmed peritonitis.
Materials And Methods:
This single-center, retrospective study included patients aged ≥18 years who were followed up with a culture-confirmed diagnosis of peritonitis.
Results:
Of the 134 patients, 54.5% (n=73) were male, and the mean age was 57.9 ± 16.1 years. Forty-three patients (32.1%) had primary peritonitis and 91 (67.9%) had secondary peritonitis. A total of 157 pathogens were isolated from 134 cases. The most common microorganisms were Escherichia coli (19.1%, n=9/47), coagulase-negative staphylococci (CoNS) (12.7%, n=6/47), Pseudomonas spp.(12.7%, n=6/47), Enterococcus spp. (10.6%, n=5/47), and Staphylococcus aureus (10.6%, n=5/47) in primary peritonitis and E. coli (27.3%, n=30/110), Enterococcus spp. (15.4%, n=17/110), Klebsiella pneumoniae (13.6%, n=15/110), Pseudomonas spp.(10.9%, n=12/110), and Candida spp. (%10.0, n=11/110) in secondary peritonitis. Among E. coli species, extended-spectrum beta-lactamase (ESBL) rates were 33% (n=3/9) in primary peritonitis and 63% (n=19/30) in secondary peritonitis. The 30-day mortality rate was 36.5% (n=49/134). Male gender (69.4% vs. 45.9%, p=0.009) and secondary perforation (14.3% vs. 4.7%, p=0.049) were more common in deceased patients, while peritonitis associated with peritoneal dialysis (2.0% vs. 11.7%, p=0.048) and peritonitis due to CoNS (0.0% vs. 9.4%, p=0.027) were less common in deceased patients than survivors. In addition, advanced age (63.6 ± 16.6 vs. 54.7 ± 14.9, p=0.001) and high aspartate aminotransferase (AST) levels (147 ± 412 vs. 135 ± 501, p=0.010) were associated with mortality.
Conclusions:
This study highlights the importance of demographic characteristics, clinical features, and laboratory parameters for clinical outcomes in patients with peritonitis. Patients with secondary perforation-related peritonitis require close monitoring for clinical changes. Gram-positive bacteria and sensitive enteric bacilli for primary peritonitis and ESBL-producing Gram-negative bacteria for secondary peritonitis should be included in empirical treatment selection. Additionally, we recommend considering antifungal agents for severely ill patients with secondary peritonitis.
Insights
This study identified key risk factors for peritonitis mortality, including male gender, advanced age, and secondary perforation. Empirical treatment should target common pathogens like E. coli and consider resistance profiles for better patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Peritonitis, an inflammation of the peritoneum, presents significant clinical challenges with varying outcomes.
- Understanding the spectrum of causative microorganisms, their resistance patterns, and associated risk factors is crucial for effective management.
Purpose of the Study:
- To identify pathogenic microorganisms and their antibiotic resistance profiles in patients with culture-confirmed peritonitis.
- To analyze clinical outcomes and determine mortality-related risk factors in this patient population.
Main Methods:
- A single-center, retrospective study involving adult patients (≥18 years) diagnosed with culture-confirmed peritonitis.
- Data collected included patient demographics, peritonitis type (primary vs. secondary), isolated pathogens, antimicrobial resistance, clinical course, and mortality.
Main Results:
- The study analyzed 134 patients, with 36.5% 30-day mortality. Common pathogens included Escherichia coli, coagulase-negative staphylococci, Pseudomonas spp., Enterococcus spp., and Staphylococcus aureus.
- Extended-spectrum beta-lactamase (ESBL) rates were notably high in E. coli isolates (33% in primary, 63% in secondary peritonitis).
- Mortality was associated with male gender, advanced age, high AST levels, and secondary perforation, while peritoneal dialysis-associated peritonitis and CoNS infections were less common in deceased patients.
Conclusions:
- Demographic, clinical, and laboratory factors significantly influence peritonitis outcomes.
- Empirical treatment strategies should be tailored based on peritonitis type and local resistance patterns, considering Gram-positive bacteria and sensitive enteric bacilli for primary peritonitis, and ESBL-producing Gram-negative bacteria for secondary peritonitis.
- Close monitoring and consideration of antifungal agents for severely ill patients with secondary peritonitis are recommended.
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