• Humans
• Adult
• Anti-Bacterial Agents/therapeutic use
• Retrospective Studies
• Prospective Studies
• Gram-Positive Bacterial Infections/drug therapy
• Enterococcus
• Anti-Infective Agents/therapeutic use
• Intraabdominal Infections/complications
• Intraabdominal Infections/drug therapy
• Neoplasms/complications
• Neoplasms/drug therapy

• allergy
• beta-lactam
• intra-abdominal infection
• outcomes
• penicillin

• intra-abdominal infections
• sepsis
• sepsis team

• National Natural Science Foundation of China
• Natural Science Foundation of Guangdong Province

To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications.

Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis.

Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p < 0.001 and 41 [24–66] vs. 17 [7–32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI.

CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.

• Intensive care unit
• Intra-abdominal infection
• Microbiology
• Outcome
• Peritonitis

Despite improvements in diagnosis, intensive-care medicine and surgical technique, the mortality of patients with secondary peritonitis is still high. Early and aggressive empiric antibiotic treatment has strong impact on the outcome. This retrospective study investigates bacterial and fungal pathogens and their antibiotic sensitivity in patients with secondary peritonitis. All patients that underwent emergency laparotomy due to secondary peritonitis at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2005 and 2015 were reviewed and overall 414 patients were included. We correlated the intra-abdominal localization of the organ perforation with intraoperative microbiological findings and corresponding sensitivities to relevant antibiotics. Overall, the most common findings were Escherichia coli (39%) and other Enterobacterica (24%). Depending on the location of the perforation, Cefuroxime/Metronidazole and Cefutaxime/Metronidazole were effective (based on in vitro susceptibility testing) in only 55–73% of the patients, while Meropenem/Vancomycin was able to control the peritonitis in more than 98% of the patients; independent of the location. Besides early source control, appropriate empiric treatment plays a pivotal role in treatment of secondary peritonitis. We are able to show that the frequently used combinations of second or third generation Cephalosporins with Metronidazole are not always sufficient, which is due to the biological resistance of the bacteria. Further clinical studies are needed to determine whether calculated use of broad-spectrum antibiotics with a sensitivity rate > 99%, such as Carbapenem plus Vancomycin, can improve overall survival rates in critically ill patients with secondary peritonitis.

• Enterococcus
• antibiotic stewardship
• community-acquired intra-abdominal infection
• health-care–associated or hospital-acquired intra-abdominal infection
• intra-abdominal infection

• Antimicrobial Susceptibility
• Epidemiology
• Intraabdominal Infections

• Anti-Bacterial Agents/pharmacology
• Bacteria/drug effects
• Humans
• Intraabdominal Infections/drug therapy
• Intraabdominal Infections/microbiology
• Microbial Sensitivity Tests

• Chong Kun Dang Pharmaceutical Corp

• Candida
• Enterococcus
• Intra-abdominal infections
• Mortality
• Multidrug-resistance

Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp.

Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality.

Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3–15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0–10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors.

An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months.

The online version of this article (10.1186/s13054-019-2581-8) contains supplementary material, which is available to authorized users.

• Antibiotic therapy
• Enterococcus spp.
• Intensive care
• Intraabdominal infections
• Mortality

• Acute abdomen
• Anastomotic leakage
• Antibiotic treatment
• Postoperative peritonitis

• Cephalosporins
• Ciprofloxacin
• Fluoroquinolones
• Intra-abdominal infection
• Moxifloxacin
• Peritonitis

Early recognition of sepsis is a key factor to improve survival to this disease in surgical patients, since it allows prompt control of the infectious source. Combining pro-inflammatory and immunosupression biomarkers could represent a good strategy to improve sepsis detection. Here we evaluated the combination of procalcitonin (PCT) with gene expression levels of HLA-DRA to detect sepsis in a cohort of 154 surgical patients (101 with sepsis and 53 with no infection). HLA-DRA expression was quantified using droplet digital PCR, a next-generation PCR technology. Area under the receiver operating curve analysis (AUROC) showed that the PCT/HLA-DRA ratio outperformed PCT to detect sepsis (AUROC [CI95%], p): PCT: 0.80 [0.73–0.88], <0.001; PCT/HLA-DRA: 0.85 [0.78–0.91], <0.001. In the multivariate analysis, the ratio showed a superior ability to predict sepsis compared to that of PCT (OR [CI 95%], p): PCT/HLA-DRA: 7.66 [1.82–32.29], 0.006; PCT: 4.21 [1.15–15.43] 0.030. Multivariate analysis was confirmed using a new surgical cohort with 74 sepsis patients and 21 controls: PCT/HLA-DRA: 34.86 [1.22–995.08], 0.038; PCT: 5.52 [0.40–75.78], 0.201. In conclusion, the combination of PCT with HLA-DRA is a promising strategy for improving sepsis detection in surgical patients.

• Infections
• Organ dysfunction
• Sepsis
• Septic shock

• Arterial Pressure
• Consensus
• Data Accuracy
• Glasgow Coma Scale
• Humans
• Organ Dysfunction Scores
• Sensitivity and Specificity
• Sepsis/classification
• Sepsis/mortality
• Severity of Illness Index

• P50 GM111152 NIGMS NIH HHS

• abdominal infection
• antimicrobial management
• empiric antimicrobial therapy
• health-care–associated infection
• multi-drug–resistant

• Enterococcus faecalis
• Enterococcus faecium
• animal models
• model hosts
• polymicrobial infection
• virulence factors

• Animals
• Anti-Bacterial Agents/pharmacology
• Biofilms/drug effects
• Disease Models, Animal
• Enterococcus faecalis/drug effects
• Enterococcus faecalis/genetics
• Enterococcus faecalis/growth & development
• Enterococcus faecalis/physiology
• Enterococcus faecium/drug effects
• Enterococcus faecium/genetics
• Enterococcus faecium/growth & development
• Enterococcus faecium/physiology
• Gram-Positive Bacterial Infections/microbiology
• Humans

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

• Antibiotics
• Intra-abdominal infections
• Peritonitis
• Sepsis

To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP).

This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded.

A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P < 0.001), postoperative medical complications (OR = 6.02; 95%CI: 1.95-18.55, P < 0.001) and the number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality.

The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.

• Mortality
• Postoperative peritonitis
• Risk factors
• Surgery

• antimicrobial agent
• outcome
• protocol compliance
• secondary peritonitis

• Anti-Bacterial Agents
• Anti-Infective Agents
• Cross Infection
• Humans
• Intraabdominal Infections
• Prospective Studies

AIM: To determine the therapeutic effects of exogenous macrophages (U937) in mice with bacterial peritonitis.

METHODS: Sixty mice were randomized into three groups. Group A received injections of E. coli suspension and PBS. Group B received injections of E. coli suspension and gentamycin. Group C received injections of E. coli suspension and activated U937 cells. All dosages, included median lethal dose (LD50) of E. coli and maximum safe doses of activated U937 cells and gentamycin, were determined by pre-tests.

RESULTS: The weight and general condition of mice in groups B and C were significantly better than those of group A (P< 0.05). The fatality rate in groups B and C was lower than that of group A. Compared with group C, general condition and weight of mice in group B were better. The fatality rate in group B was 0, while that of group C was 20% (P < 0.01).

CONCLUSION: As a treatment for bacterial peritonitis, exogenous macrophages (U937) are better than gentamycin.

• Bacterial peritonitis
• E.coli
• Macrophages
• Gentamycin
• Fatality rate

Secondary peritonitis requires surgical source control and adequate antimicrobial treatment. Antimicrobial regimens are usually selected according to local susceptibility data of individual pathogens against single agents, but this neglects both the polymicrobial nature of the infection and the use of combination therapy. We analysed the probability of common regimens to cover all relevant pathogens isolated in one patient (“spectrum adequacy rate”, SAR) in a real-life data set.

Data from 242 patients with secondary peritonitis (88 community acquired, 154 postoperative cases) treated in our IMCU/ICU were obtained retrospectively. The relative frequency of pathogens, resistance rates and the SAR were analysed using the free software R.

Enterococci were isolated in 47.1 % of all patients, followed by Escherichia coli (42.6 %), other enterobacteriaceae (33.1 %), anaerobes (29.8 %) and Candida spp. (28.9 %). Resistance patterns were consistent with general surveillance data from our hospital. The susceptibility rates and SAR were lower in postoperative than in community acquired cases. The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin. When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised. As for Candida spp., the SAR of fluconazole was 81.9–87.5 %.

This study demonstrates a rational approach to assess the adequacy of antimicrobial regimens in secondary peritonitis, which may help to adjust local guidelines or to select candidate regimens for clinical studies.

• Anti-Bacterial Agents/administration & dosage
• Female
• Humans
• Intraabdominal Infections/drug therapy
• Male
• Sepsis/drug therapy

• R01 GM081510 NIGMS NIH HHS
• T32 AI078875 NIAID NIH HHS

• Adult
• Aged
• Aged, 80 and over
• Bacteriuria/epidemiology
• Bacteriuria/microbiology
• Bacteriuria/pathology
• Coinfection/epidemiology
• Coinfection/microbiology
• Coinfection/pathology
• Enterococcus faecalis/isolation & purification
• Epidemiologic Studies
• Female
• France/epidemiology
• Gram-Positive Bacterial Infections/epidemiology
• Gram-Positive Bacterial Infections/microbiology
• Gram-Positive Bacterial Infections/pathology
• Hospitals, University
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Young Adult

Persistent peritonitis is a frequent complication of secondary peritonitis requiring additional reoperations and antibiotic therapy. This situation raises specific concerns due to microbiological changes in peritoneal samples, especially the emergence of multidrug-resistant (MDR) strains. Although this complication has been extensively studied, the rate and dynamics of MDR strains have rarely been analysed.

We compared the clinical, microbiological and therapeutic data of consecutive ICU patients admitted for postoperative peritonitis either without subsequent reoperation (n = 122) or who underwent repeated surgery for persistent peritonitis with positive peritoneal fluid cultures (n = 98). Data collected on index surgery for the treatment of postoperative peritonitis were compared between these two groups. In the patients with persistent peritonitis, the data obtained at the first, second and third reoperations were compared with those of index surgery. Risk factors for emergence of MDR strains were assessed.

At the time of index surgery, no parameters were able to differentiate patients with or without persistent peritonitis except for increased severity and high proportions of fungal isolates in the persistent peritonitis group. The mean time to reoperation was similar from the first to the third reoperation (range: 5 to 6 days). Septic shock was the main clinical expression of persistent peritonitis. A progressive shift of peritoneal flora was observed with the number of reoperations, comprising extinction of susceptible strains and emergence of 85 MDR strains. The proportion of patients harbouring MDR strains increased from 41% at index surgery, to 49% at the first, 54% at the second (P = 0.037) and 76% at the third reoperation (P = 0.003 versus index surgery). In multivariate analysis, the only risk factor for emergence of MDR strains was time to reoperation (OR 1.19 per day, 95%CI (1.08 to 1.33), P = 0.0006).

Initial severity, presence of Candida in surgical samples and inadequate source control are the major risk factors for persistent peritonitis. Emergence of MDR bacteria is frequent and increases progressively with the number of reoperations. No link was demonstrated between emergence of MDR strains and antibiotic regimens, while source control and its timing appeared to be major determinants of emergence of MDR strains.

• Candida albicans
• RIM101
• SAP5
• in vivo gene expression
• intra-abdominal candidiasis
• nanoString

• digestive fistula
• hyperthermic intraperitoneal chemotherapy
• peritoneal carcinomatosis
• postoperative peritonitis
• spontaneous bacterial peritonitis

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient’s condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient’s good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

• Fish bone ingestion
• Micro-perforation
• Decision-making
• Medical treatment
• Small intestine

• Aged
• Aged, 80 and over
• Critical Care
• Critical Illness/mortality
• Enterococcaceae/drug effects
• Enterococcaceae/isolation & purification
• Enterococcaceae/pathogenicity
• Female
• Gram-Positive Bacterial Infections/microbiology
• Gram-Positive Bacterial Infections/mortality
• Hospital Mortality
• Humans
• Intraabdominal Infections/microbiology
• Intraabdominal Infections/mortality
• Male
• Multiple Organ Failure/microbiology
• Multiple Organ Failure/mortality
• Retrospective Studies
• Treatment Outcome

• Anti-Infective Agents/therapeutic use
• Europe
• Evidence-Based Medicine
• Humans
• Peritonitis/drug therapy
• Peritonitis/microbiology
• Practice Guidelines as Topic

• Abdomen
• Abdominal Abscess/complications
• Abdominal Abscess/drug therapy
• Abdominal Abscess/microbiology
• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/classification
• Anti-Bacterial Agents/therapeutic use
• Antifungal Agents/therapeutic use
• Bacterial Infections/complications
• Bacterial Infections/drug therapy
• Bacterial Infections/microbiology
• Candidiasis, Invasive/complications
• Candidiasis, Invasive/drug therapy
• Community-Acquired Infections/microbiology
• Critical Care
• Cross Infection/microbiology
• Decision Trees
• Drug Resistance, Microbial
• Humans
• Peritonitis/classification
• Peritonitis/complications
• Peritonitis/drug therapy
• Peritonitis/microbiology
• Pseudomonas Infections/drug therapy
• Risk
• Sepsis/etiology
• Sepsis/prevention & control
• Severity of Illness Index
• Unnecessary Procedures