[Intraperitoneal infections and immunosuppression (author's transl)]

Area of Science:

• Surgical infections
• Immunology
• Critical care medicine

Context:

• Intraperitoneal infections, particularly peritonitis, pose significant challenges in patients with compromised immune defenses.
• Normal immune responses, including phagocyte activity and cellular immunity, are altered in immunocompromised individuals.
• Iatrogenic, congenital, or acquired immune deficiencies significantly impact the presentation and management of abdominal infections.

Purpose:

• To highlight the diagnostic and therapeutic challenges of intraperitoneal infections in patients with restricted immune defense.
• To emphasize the altered clinical presentation and the need for early diagnostic interventions.
• To discuss the implications of a changed microbial spectrum and the necessity for modified antibiotic strategies.

Summary:

• Patients with restricted immune defense often lack typical peritonitis symptoms like abdominal tenderness due to reduced granulocytes, necessitating early diagnostic lavage.
• While general peritonitis treatment principles apply, the altered germ spectrum, including opportunistic pathogens, requires adjusted antibiotic therapy.
• Prognosis is heavily influenced by infection etiology and the degree of immunosuppression, with current mortality rates reaching up to 70%.

Impact:

• Informs surgical practice regarding the nuanced management of peritonitis in immunocompromised patients.
• Underscores the importance of early diagnostic interventions to improve outcomes in a high-risk population.
• Highlights the need for further research into optimizing antimicrobial strategies and supportive care for peritonitis in immunocompromised individuals.