[Stage-oriented antibiotic therapy of peritonitis. Prospective study]

Area of Science:

• Surgical Gastroenterology
• Infectious Diseases
• Clinical Microbiology

Background:

• Diffuse peritonitis presents a significant clinical challenge with varying severity.
• Effective management requires tailored surgical and antibiotic approaches.
• The Mannheim Peritonitis Score (MPS) stratifies patients based on prognosis.

Purpose of the Study:

• To evaluate the efficacy of different surgical procedures and antibiotic regimens for diffuse peritonitis.
• To assess the impact of the Mannheim Peritonitis Score on treatment outcomes and mortality.
• To compare observed mortality rates with statistically expected rates.

Main Methods:

• Prospective study of 25 consecutive patients with diffuse peritonitis.
• Patients stratified into three groups (A, B, C) based on the Mannheim Peritonitis Score (MPS).
• Group A (MPS 0-20): standard procedure. Group B (MPS 21-29): closed postoperative lavage. Group C (MPS > 29): Etappenlavage (reexplorations and lavage).
• Antibiotic regimens varied: Groups A/B received cefotaxime and metronidazole; Group C received cefotaxime, metronidazole, and ofloxacin.

Main Results:

• Mortality rates were 0% for Group A (8 patients), 20% for Group B (10 patients), and 29% for Group C (7 patients).
• Overall observed mortality was 16% (4/25 patients).
• The observed overall mortality was significantly lower than the statistically expected mortality of 36% (APACHE-II-Score, P = 0.0982).

Conclusions:

• Tailored surgical strategies and selective antibiotic regimens based on the Mannheim Peritonitis Score are effective in managing diffuse peritonitis.
• This approach leads to reduced mortality compared to predicted outcomes.
• The study highlights the importance of risk stratification in optimizing treatment for peritonitis.