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Intensive Care Medicine

, Volume 42, Issue 8, pp 1234–1247 | Cite as

Therapeutic management of peritonitis: a comprehensive guide for intensivists

  • P. MontraversEmail author
  • S. Blot
  • G. Dimopoulos
  • C. Eckmann
  • P. Eggimann
  • X. Guirao
  • J. A. Paiva
  • G. Sganga
  • J. De Waele
My Paper 20 Years Later

Abstract

Purpose

The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) bacteria.

Methods

A multidisciplinary panel summarizes the latest advances in the therapeutic management of these critically ill patients.

Results

Appendicitis, cholecystitis and bowel perforation represent the majority of all community-acquired infections, while most cases of healthcare-associated infections occur following suture leaks and/or bowel perforation. The micro-organisms involved include a spectrum of Gram-positive and Gram-negative bacteria, as well as anaerobes and fungi. Healthcare-associated infections are associated with an increased likelihood of MDR pathogens. The key elements for success are early and optimal source control and adequate surgery and appropriate antibiotic therapy. Drainage, debridement, abdominal cleansing, irrigation, and control of the source of contamination are the major steps to ensure source control. In life-threatening situations, a "damage control" approach is the safest way to gain time and achieve stability. The initial empirical antiinfective therapy should be prescribed rapidly and must target all of the micro-organisms likely to be involved, including MDR bacteria and fungi, on the basis of the suspected risk factors. Dosage adjustment needs to be based on pharmacokinetic parameters. Supportive care includes pain management, optimization of ventilation, haemodynamic and fluid monitoring, improvement of renal function, nutrition and anticoagulation.

Conclusions

The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.

Keywords

Peritonitis Source control Multidrug-resistant bacteria Fungal infection Postoperative complications Intra-abdominal hypertension 

Notes

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2016_4307_MOESM1_ESM.doc (70 kb)
Supplementary material 1 (DOC 70 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • P. Montravers
    • 1
    Email author
  • S. Blot
    • 2
    • 10
  • G. Dimopoulos
    • 3
  • C. Eckmann
    • 4
  • P. Eggimann
    • 5
  • X. Guirao
    • 6
  • J. A. Paiva
    • 7
    • 11
  • G. Sganga
    • 8
  • J. De Waele
    • 9
  1. 1.APHP, CHU Bichat-Claude Bernard, Département d’Anesthésie RéanimationUniversité Denis Diderot, PRESS Sorbonne CitéParisFrance
  2. 2.Department of Internal MedicineGhent UniversityGhentBelgium
  3. 3.Department of Critical CareUniversity Hospital Attikon, Medical School, University of AthensAthensGreece
  4. 4.Department of General, Visceral and Thoracic SurgeryKlinikum PeinePeineGermany
  5. 5.Department of Intensive Care Medicine and Burn CenterCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  6. 6.Department of Endocrine and Head and Neck SurgeryCorporació Sanitaria del Parc Tauli, University HospitalSabadell, BarcelonaSpain
  7. 7.Emergency and Intensive Care DepartmentCentro Hospitalar S. João EPEPortoPortugal
  8. 8.Department of SurgeryCatholic University of Sacred Heart, Policlinico A GemelliRomeItaly
  9. 9.Department of Critical Care MedicineGhent University HospitalGhentBelgium
  10. 10.Burns, Trauma and Critical Care Research CentreThe University of QueenslandBrisbaneAustralia
  11. 11.Department of Medicine, Faculty of MedicineUniversity of PortoPortoPortugal

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