Abstract
This prospective non-interventional study is aimed at evaluating the role of enterococci in the postoperative course of postoperative peritonitis (POP) and the predictive factors for isolating Enterococcus spp. All adult patients, hospitalized in intensive care, who had POP between September 2006 and February 2010 were analysed. The patients’ baseline clinical characteristics and microbiological and surgical characteristics of the first episode of POP were recorded. The rates of surgical and non-surgical complications and mortality were studied. A total of 139 patients were analysed and Enterococcus spp. were recovered in 61 patients (43%). The presence of enterococci was associated with significantly more intra-abdominal abscesses (26% vs 12%, p = 0.025), but did not affect the rate of reoperation or mortality. Antibiotic use before reoperation was the only independent predictive factor for isolating enterococci (OR = 2.19, CI95%: 1.02–4.70, p < 0.043). Although mortality was not affected by the presence of Enterococcus spp., a higher rate of intra-abdominal abscess was found, suggesting that enterococci play a significant role in postoperative peritonitis, but the need to treat them remains to be determined. Previous antibiotic use before reoperation was a key factor in predicting the subsequent recovery of enterococci.
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Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 50(2):133–164
Augustin P, Kermarrec N, Muller-Serieys C, Lasocki S, Chosidow D, Marmuse JP, Valin N, Desmonts JM, Montravers P (2010) Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis. Crit Care 14(1):R20
Roehrborn A, Thomas L, Potreck O, Ebener C, Ohmann C, Goretzki PE, Roher HD (2001) The microbiology of postoperative peritonitis. Clin Infect Dis 33(9):1513–1519
Seguin P, Fedun Y, Laviolle B, Nesseler N, Donnio PY, Malledant Y (2010) Risk factors for multidrug-resistant bacteria in patients with post-operative peritonitis requiring intensive care. J Antimicrob Chemother 65(2):342–346
Seguin P, Laviolle B, Chanavaz C, Donnio PY, Gautier-Lerestif AL, Campion JP, Malledant Y (2006) Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy. Clin Microbiol Infect 12(10):980–985
Dupont H, Carbon C, Carlet J (2000) Monotherapy with a broad-spectrum betalactam is as effective as its combination with an aminoglycoside in treatment of severe generalized peritonitis: a multicenter randomized controlled trial. The Severe Generalized Peritonitis Study Group. Antimicrob Agents Chemother 44(8):2028–2033
Riché FC, Dray X, Laisne MJ, Mateo J, Raskine L, Sanson-Le Pors MJ, Payen D, Valleur P, Cholley BP (2009) Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis. Crit Care 13(3):R99
Burnett RJ, Haverstock DC, Dellinger EP, Reinhart HH, Bohnen JM, Rotstein OD, Vogel SB, Solomkin JS (1995) Definition of the role of enterococcus in intraabdominal infection: analysis of a prospective randomized trial. Surgery 118(4):716–721; discussion 721–713
Mazuski JE, Sawyer RG, Nathens AB, DiPiro JT, Schein M, Kudsk KA, Yowler C (2002) The Surgical Infection Society guidelines on antimicrobial therapy for intraabdominal infections: evidence for the recommendations. Surg Infect (Larchmt) 3(3):175–233
Cercenado E, Torroba L, Canton R, Martinez-Martinez L, Chaves F, Garcia-Rodriguez JA, Lopez-Garcia C, Aguilar L, Garcia-Rey C, Garcia-Escribano N, Bouza E (2010) Multicenter study evaluating the role of enterococci in secondary bacterial peritonitis. J Clin Microbiol 48(2):456–459
Sitges-Serra A, Lopez MJ, Girvent M, Almirall S, Sancho JJ (2002) Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg 89(3):361–367
Sotto A, Lefrant JY, Fabbro-Peray P, Muller L, Tafuri J, Navarro F, Prudhomme M, De La Coussaye JE (2002) Evaluation of antimicrobial therapy management of 120 consecutive patients with secondary peritonitis. J Antimicrob Chemother 50(4):569–576
Bone RC, Sibbald WJ, Sprung CL (1992) The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 101(6):1481–1483
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149(3 Pt 1):818–824
Bellomo R, Kellum J, Ronco C (2001) Acute renal failure: time for consensus. Intensive Care Med 27(11):1685–1688
Matlow AG, Bohnen JM, Nohr C, Christou N, Meakins J (1989) Pathogenicity of enterococci in a rat model of fecal peritonitis. J Infect Dis 160(1):142–145
Montravers P, Andremont A, Massias L, Carbon C (1994) Investigation of the potential role of Enterococcus faecalis in the pathophysiology of experimental peritonitis. J Infect Dis 169(4):821–830
Onderdonk AB, Bartlett JG, Louie T, Sullivan-Seigler N, Gorbach SL (1976) Microbial synergy in experimental intra-abdominal abscess. Infect Immun 13(1):22–26
Weinstein WM, Onderdonk AB, Bartlett JG, Louie TJ, Gorbach SL (1975) Antimicrobial therapy of experimental intraabdominal sepsis. J Infect Dis 132(3):282–286
Cohn SM, Lipsett PA, Buchman TG, Cheadle WG, Milsom JW, O'Marro S, Yellin AE, Jungerwirth S, Rochefort EV, Haverstock DC, Kowalsky SF (2000) Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections. Ann Surg 232(2):254–262
Ohlin B, Cederberg A, Forssell H, Solhaug JH, Tveit E (1999) Piperacillin/tazobactam compared with cefuroxime/metronidazole in the treatment of intra-abdominal infections. Eur J Surg 165(9):875–884
Solomkin JS, Yellin AE, Rotstein OD, Christou NV, Dellinger EP, Tellado JM, Malafaia O, Fernandez A, Choe KA, Carides A, Satishchandran V, Teppler H (2003) Ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections: results of a double-blind, randomized comparative phase III trial. Ann Surg 237(2):235–245
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Seguin, P., Brianchon, C., Launey, Y. et al. Are enterococci playing a role in postoperative peritonitis in critically ill patients?. Eur J Clin Microbiol Infect Dis 31, 1479–1485 (2012). https://doi.org/10.1007/s10096-011-1467-8
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DOI: https://doi.org/10.1007/s10096-011-1467-8