Skip to main content
SpringerLink
Log in

Infectiological diagnostic problems in tertiary peritonitis

  • Original article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The tertiary peritonitis causes the highest mortality in intraabdominal infections. Surgical interventions and antibiotic therapy may only provide an incomplete impact on nosocomial infections acquired at an intensive care unit (ICU) [Nathens et al., World J Surg 22:158–163, 28]. To open up new resources in the management, in particular, in the previous infectious diagnostic, the aim was to investigate the infectious course as well as the diagnostic value of laboratory parameters and microbiological monitoring.

Materials and methods

In this retrospective patient cohort study from the Surgical ICU of a University Hospital (capacity, n=12), overall, 60 patients with a tertiary peritonitis were enrolled.

Results

Approximately 20% of the patients with an intraabdominal infection developed a tertiary peritonitis. A tertiary peritonitis can more frequently develop in nosocomial intraabdominal infections, in particular, in case of necrotizing pancreatitis. The device-associated infection rate in the spectrum of nosocomial infections is sevenfold higher than in all ICU patients. Compared with the secondary peritonitis, its mortality is double as high: 35%. In the diagnostic characterizing the course of the nosocomial, prognosis-relevant infections, usual inflammatory parameters show a considerable loss of their sensitivity with a range from 35–57%. By the mean of a routine microbiological monitoring, 47.3% of the analysed subsequent infections could be identified at an early stage.

Conclusion

In patients with a severe infection, an early diagnostic and treatment of infectious “second hits” can improve the complication rate and prognosis. During the prolonged and complicated septic course of tertiary peritonitis, an additional routine microbiological monitoring contributed effectively to early detection and diagnostic of nosocomial infections. Further studies to investigate the value and efficacy of such monitoring, which have been abandoned, should be undertaken in infectious high-risk patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bosscha K, van Vroonhoven Th, van der Werken Ch (1999) Surgical management of secondary peritonitis. Br J Surg 86:1371–1377

    Article  PubMed  CAS  Google Scholar 

  2. Brünnler T, Langgartner J, Klebl F, Salzberger B, Schölmerich J (2004) Mikrobiologische Routinediagnostik auf der Intensivstation–ein Update. Intensivmed 41:248–254

    Article  Google Scholar 

  3. Buijk SE, Bruining HA (2002) Future directions in the management of tertiary peritonitis. Intensive Care Med 28:1024–1029

    Article  PubMed  CAS  Google Scholar 

  4. Calandra T, Cohen J (2005) The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33:1538–1548

    Article  PubMed  Google Scholar 

  5. Cendrero JAC, Violan JS, Benitez AB, Catalan JN, Fernandez JA, Santana PS, de Castro FR (1999) Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 116:462–470

    Article  Google Scholar 

  6. Crabtree TD, Pelletier SJ, Antevil JL, et al (2001) Cohort study of fever and leukocytosis as diagnostic and prognostic indicators in infected surgical patients. World J Surg 25:739–744

    Article  PubMed  CAS  Google Scholar 

  7. Engelmann L (2003) Patienten mit Sepsis versterben am “second hit”. Intensiv-News 5:1–2

    Google Scholar 

  8. Evans HL, Raymond DP, Shawn JP et al (2001) Diagnosis of intraabdominal infection in critically ill patient. Curr Opin Crit Care 7:117–121

    Article  PubMed  CAS  Google Scholar 

  9. Ewig S, Torres A, Elebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Am J Respir Crit Care Med 159:188–198

    PubMed  CAS  Google Scholar 

  10. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez F, Perez-Paredes C, Ortiz-Leyba C (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2752

    Article  PubMed  Google Scholar 

  11. Garrouste-Oregas M, Chevret S, Arlet G, Marie O, Rouveau M, Popoff N, Schlemmer B (1997) Oropharngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. Am J Respir Crit Care Med 56:1647–1655

    Google Scholar 

  12. Graevenitz A (1995) Bakteriologisch-mykologisches “Monitoring” auf Intensivstationen. Intensivmed 32:547–551

    Google Scholar 

  13. Harbarth S, Ferriere K, Hugonnet S, Ricou B, Suter P, Pittet D (2002) Epidemiology and prognostic determinants of bloodstream infections in surgical intensive care. Arch Surg 137:1353–1359

    Article  PubMed  Google Scholar 

  14. Hauer T, Dziekan G, Krüger WA, Rüden H, Daschner F (2000) Sinnvolle und nich sinn-volle Hygienemassnahmen in der Anästhesie und auf Intensivstation. Anäesthesist 49:96–101

    Article  PubMed  CAS  Google Scholar 

  15. Hayon J, Figliolini C, Combers A, Trouillet JL, Kassis N, Dombert MC, Gibert C, Chastre J (2002) Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia. Am J Respir Crit Care Med 165:41–46

    PubMed  Google Scholar 

  16. Hoste E, Blot S, Lameire N, Vanholder R, De Bacquer D, Colardyn F (2004) Effect of nosocomial bloodstream infection on the outcome of critically ill patients with acute renal failure treated with renal replacement therapy. J Am Soc Nephrol 15:454–462

    Article  PubMed  Google Scholar 

  17. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH (2002) Clinical importance of delays in the initiation of appropriate treatment for ventilator-associated pneumonia. Chest 122:262–268

    Article  PubMed  Google Scholar 

  18. Kollef MH, Sherman G, Ward S, Fraser V (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474

    Article  PubMed  CAS  Google Scholar 

  19. Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31:131–138

    Article  Google Scholar 

  20. Kujath P, Rodloff AC (eds) (2003) Therapie chirurgischer Infektionen—Aktuelle Aspekte zur Dia-gnostik und Therapie, 1st edn. UNI-MED SCIENCE, Bremen, London, Boston:63–67

    Google Scholar 

  21. Kujath P, Rodloff AC (eds) (2001) Peritonitis—Grundlagen der Therapie der Peritonitis, 1st edn. UNI-MED SCIENCE, Bremen, London, Boston:56–69

    Google Scholar 

  22. Leone M, Bourgoin A, Cambon S, Dubue M, Albanese J, Claude M (2003) Empirical anti-microbial therapy of septic shock patients: adequacy and impact on the outcome. Crit Care Med 31:462–467

    Article  PubMed  CAS  Google Scholar 

  23. Leroy O, Meybeck A, Escrivan T, Devos P, Kipnis E, Georges H (2003) Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia. Intensive Care Med 29:2170–2173

    Article  PubMed  Google Scholar 

  24. Levin PD, Hersch M, Rudensky B, Yinnon AM (1997) Routine surveillance blood cultures: their place in the management of critically ill patients. J Infect 35:125–128

    Article  PubMed  CAS  Google Scholar 

  25. Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC (1997) Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 111:676–685

    Article  PubMed  CAS  Google Scholar 

  26. Mac Arthur R, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, Barchuk W (2004) Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Clin Infect Dis 38:284–288

    Article  Google Scholar 

  27. Marshall JC, Innes M (2003) Intensive care unit management of intraabdominal infection. Crit Care Med 31:2228–2237

    Article  PubMed  Google Scholar 

  28. Nathens AB, Rotstein O, Marshall JC (1998) Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg 22:158–163

    Article  PubMed  CAS  Google Scholar 

  29. Ortiz E, Sande MA (2000) Routine use of anaerobic blood cultures: are they still indicated? Am J Med 108:445–447

    Article  PubMed  CAS  Google Scholar 

  30. Rello J, Ausina V, Ricart M, Castella J, Prats G (1993) Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 104:1230–1235

    Article  PubMed  CAS  Google Scholar 

  31. Rello J, Gallego M, Mariscal D, Sonora R, Valles J (1997) The value of routine microbial investigation in ventilator associated pneumonia. Am J Respir Crit Care Med 156:196–200

    PubMed  CAS  Google Scholar 

  32. Ruef CH, Francioli P (1997) Mikrobiologisches Monitoring auf der Intensivstation. Swiss-NOSO 4:1–7

    Google Scholar 

  33. Scheidegger C, Zimmerli (1997) Routinemäßige bakteriologische Kontrollunter-suchungen bei Intensivpatienten: Contra. Anästhes Intensivmed Notfallmed Schmerzther 32:115–116

    Article  CAS  Google Scholar 

  34. Strouhal Um, Byhahn C, Martens S, Albert S, Mierdl S, Wimmer-Greinecker G, Westphal K, Kessler P (2000) Stellenwert bakteriologischer Screeninguntersuchungen bei Patienten mit Sepsis auf einer herzchirurgischen Intensivstation. Z Herz-Thorax-Gefässchir 14:137–142

    Article  Google Scholar 

  35. Timothy CF (2000) Empiric therapy for pneumonia in the surgical intensive care unit. Am J Surg 179:18S–25S

    Article  Google Scholar 

  36. Thülig B, v. Saene HKF, Hartenauer U (1994) Mikrobiologische Überwachung. In: Praxis der Intensivbehandlung, 6th edn. Georg Thieme Verlag, Stuttgart, New York:121–147

    Google Scholar 

  37. Valles J, Leon C, Alvarez-Lerma F (1992) Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 15:866–873

    Google Scholar 

  38. Wichelhaus TA, Schäfer V, Brade (1999) Keimnachweis in der Blutkultur. Zentralbl Chir 124:699–702

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the collaborators of the Institute of Microbiology (Head, Prof. W. Koenig, MD) at the University Hospital, Magdeburg (Germany) for routine microbiological test cultures and providing test results.

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital, Magdeburg, Germany

    G. Weiss, F. Meyer & H. Lippert

  2. Department of Anesthesiology/Intensive Care Medicine, Städtisches Klinikum Magdeburg, Birkenallee 34, 39130, Magdeburg, Germany

    G. Weiss

Authors
  1. G. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Lippert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Weiss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weiss, G., Meyer, F. & Lippert, H. Infectiological diagnostic problems in tertiary peritonitis. Langenbecks Arch Surg 391, 473–482 (2006). https://doi.org/10.1007/s00423-006-0071-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-006-0071-3

Keywords

Search

Navigation