Materiały źródłowe

• #1 Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6955529/

  Globally, acute generalised peritonitis (AGP) is a common medical and surgical emergency which is a major contributor to non-trauma deaths despite improvements in diagnosis and surgical and intensive care management. […] AGP affects about 9.3 patients per 1000 hospital admissions and requires adequate preoperative resuscitation to avert high perioperative morbidity and mortality. […] Although AGP is one of the most frequent surgical emergencies at the global level, it has been reported to disproportionately affect low-income and middle-income countries especially the sub-Saharan African (SSA) region both in terms of prevalence and mortality rates. […] The most common types of AGP in a recent series of 305 cases in SSA were perforated gastroduodenal ulcers, perforated appendicitis and typhoid ileal perforation.

• #2 Peritonitis and Abdominal Sepsis: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/180234-overview

  The overall incidence of peritoneal infection and abscess is difficult to establish and varies with the underlying abdominal disease processes. Spontaneous bacterial peritonitis (SBP) occurs in both children and adults and is a well-known and ominous complication of cirrhosis. Of patients with cirrhosis who have SBP, 70% are Child-Pugh class C. In these patients, the development of SBP is associated with a poor long-term prognosis. […] Once thought to occur only in those individuals with alcoholic cirrhosis, SBP is known to affect patients with cirrhosis from any cause. In patients with ascites, the prevalence may be as high as 18%. This number has grown from 8% over the past two decades, most likely secondary to an increased awareness of SBP and heightened threshold to perform diagnostic paracentesis. […] Although the etiology and incidence of hepatic failure differ between children and adults, in those individuals with ascites, the incidence of SBP is roughly equal. Two peak ages for SBP are characteristic in children: one in the neonatal period and the other at age 5 years.

• #3 Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6955529/

  The postoperative mortality rates of AGP vary between 8.4% and 34% from isolated studies. […] Various aetiologies of AGP that contribute to the death toll in SSA have been described as follows; typhoid perforation of the terminal ileum (34.7 %), postoperative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %), perforated appendicitis (8.7 %), and perforation of the sigmoid colon (8.7 %). […] AGP increases the risk of perioperative morbidity and mortality, and it incurs a high economic burden on affected patients, families and the health system as a whole. […] Despite the tremendous progress in laboratory tests, imagining studies, perioperative resuscitation, surgical techniques and intensive care treatment, the management of AGP is still highly complex and represents a major challenge for all surgical and anaesthetist teams. […] Hence, it is necessary to have accurate data on the global epidemiology of AGP in order to curb its burden.

• #4 Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38371644/

  the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP). […] we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo. […] Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. […] the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. […] In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

• #5 Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases

  https://www.panafrican-med-journal.com//content/article/47/1/full

  Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases […] the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP). […] we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo. […] the population of this study was young with a mean age was 28.9 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M:F of 0.8. […] Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. […] Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. […] the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. […] In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study. […] In the Democratic Republic of Congo, a study carried out in Butembo showed that acute generalized peritonitis is the second most common cause of abdominal emergencies after appendicitis, and its main etiology is typhoid perforation. […] In the subtropical countries of Africa, the delay in the management of patients with AGP is at the root of a worse prognosis. […] The objective of this multicentre study is to describe sociodemographic, clinical, therapeutic, and prognostic characteristics, as well as costs associated with the management of AGP in semi-urban and urban hospitals within South Kivu Province. […] The most common aetiology is secondary peritonitis due to bowel perforation, particularly ileal perforation, and management of all cases is often left to non-specialists. […] Mortality is high and the cost of hospitalisation exceeds known household incomes. […] The mean cost of treating acute generalised peritonitis in urban hospitals was 800.3 USD, with a range of 457 USD to 540 USD and a mean of 377.1 USD, with a range of 350 USD to 544 USD in rural hospitals. […] The mortality rate was 14.7%. However, this rate of lethality is consistent with that of other studies conducted in sub-Saharan Africa.

• #6 Spontaneous Bacterial Peritonitis (SBP): Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/789105-overview

  In patients with ascites, the frequency may be as high as 18%. This number has grown from 8% since approximately 1995, most likely secondary to an increased awareness of spontaneous bacterial peritonitis and a lowered threshold to perform diagnostic paracentesis. […] No race predilection is known for spontaneous bacterial peritonitis. In patients with ascites, both sexes are affected equally. […] Although the etiology and incidence of hepatic failure differ between children and adults, in those individuals with ascites, the incidence of spontaneous bacterial peritonitis is roughly equal. Two peak ages for spontaneous bacterial peritonitis are characteristic in children: the first in the neonatal period and the second at age 5 years. […] According to a 2015 study by Ge and Runyon, when the initial infection was spontaneous bacterial peritonitis, subsequent infections were more likely to be caused by drug-resistant organisms. The risk of subsequent infections was increased in older patients and in patients taking proton-pump-inhibitors (PPIs) or spontaneous bacterial peritonitis prophylaxis (ie, selective intestinal decontamination).

• #7 Spontaneous bacterial peritonitis epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Spontaneous_bacterial_peritonitis_epidemiology_and_demographics

  Spontaneous bacterial peritonitis (SBP) is a potentially life threatening complication in patients with cirrhosis and has typically been described in hospitalized patients. The prevalence of SBP in cirrhotic patients with ascites admitted to the hospital ranges from 10%-30%. […] Studies have demonstrated a 12% incidence of spontaneous bacterial peritonitis in patients admitted with decompensated cirrhosis. […] The reported incidence of SBP in patients with decompensated cirrhosis is 12%. […] The incidence of SBP in asymptomatic patients presenting for a therapeutic paracentesis is 2.5%. […] In patients with ascites who underwent routine paracentesis, the incidence of active spontaneous bacterial peritonitis ranged from 10% to 27% at the time of hospital admission. […] The in-hospital mortality for SBP ranges from 10%-50% depending on many factors. […] Overall one-year mortality rate after a first episode of SBP is 30%-93% regardless of its recurrence. […] SBP is common in age group of 41-50 years and the mean age of presentation was 49 years. […] In patients with ascites both sexes are affected equally.

• #8 Spontaneous bacterial peritonitis – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_bacterial_peritonitis

  Patients with ascites underwent routine paracentesis; the incidence of active SBP ranged from 10% to 27% at the time of hospital admission.

• #9

  http://www.annalsgastro.gr/index.php/annalsgastro/article/view/5766

  Spontaneous bacterial peritonitis (SBP) is an ominous complication of decompensated cirrhosis. This study aimed to assess several epidemiological, clinical, microbiological and outcome characteristics in Greek patients with SBP, as no solid representative nationwide data of this type was available. […] During a 3-year period, 77 consecutive patients with SBP (61 male; median age: 67 years; model for end-stage liver disease [MELD] score: 20), diagnosed and followed in 5 tertiary liver units, were prospectively recruited and studied. […] Significant factors for 6-month survival were: higher MELD score, previous -blocker use, lower serum albumin, higher lactate on admission and need for vasopressors, while factors for 12-month survival were MELD score and lactate. […] In hospital-acquired SBP the prevalence of difficult-to-treat pathogens was higher.

• #10 Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135969

  Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD) patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility. The incidence of PD-associated peritonitis varies from 0.061.66 episodes/patient-year in different centers and different countries. Peritonitis can lead to treatment failure and termination of the procedure in 20% of patients and has a mortality of 26%. The Society for Peritoneal Dialysis (ISPD) has recommended center-specific empirical therapy. The ISPD guidelines emphasize the need to monitor resistance among various gram-negative bacteria. It is therefore essential to develop and implement an antibiotic stewardship program to improve empirical therapy and to monitor the resistance rates in PD-associated peritonitis.

• #11 Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135969

  We analyzed 487 susceptibility profiles of patients with PD-associated peritonitis since the PD was begun in January 1979 at the Robert-Bosch-Hospital, Germany. Over the whole study period (P1-P3) there was a slight increase of gram-negative bacteria and a slight decrease of gram-positive bacteria. The ratio of gram-negative to gram-positive bacteria increased from 0.4 in P1 to 0.5 in P3. […] In our study population, S. aureus decreased from period 1 to period 3. Proportions of peritonitis-associated CNS episodes declined from 29% in period 1 to 12% in period 3 in our patients. On the other hand, the proportions of MRSE episodes increased over the three decades to 19% as described for other populations. Interestingly, MRSA associated peritonitis remains a rare event with only two episodes in period 3.

• #12

  https://link.springer.com/article/10.1007/s00467-010-1592-0

  Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. […] Data on PD and peritonitis in pediatric patients are very scarce in developing countries. […] A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. […] The total number of peritonitis episodes was 129. […] Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0-21.2). […] Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. […] The most important risk factors for the development of peritonitis were poor housing and poor socio-economic circumstances.

• #13

  https://revistarenal.org.ar/index.php/rndt/user/setLocale/en_US?source=%2Findex.php%2Frndt%2Farticle%2Fview%2F140

  Peritonitis is the most common complication in peritoneal dialysis (PD), with an effect on morbidity and mortality. […] The total number of patients was 159, 63 (39.62%) of which had suffered from peritonitis at least once and 96 (60.38%) had never had it. The global peritonitis rate was 0.37 episodes per patient-year. […] The risk factors for peritonitis were the following: a history of hemodialysis before PD (OR=3.18; CI 95%=1.41-7.14; p=0.0051) and hypoalbuminemia (OR=3.10; CI 95%=1.36-7.06; p=0.0071). […] Although peritonitis patients showed a higher mortality rate (55.56 % versus 38.58 %; p=0.0480), the multivariate analysis revealed that this condition was not a mortality independent risk factor. […] The risk factors for peritonitis were hemodialysis prior to PD and hypoalbuminemia. Peritonitis was not a long-term mortality independent risk factor.

• #14 Fungal peritonitis in peritoneal dialysis – UpToDate

  https://www.uptodate.com/contents/fungal-peritonitis-in-peritoneal-dialysis

  Fungal peritonitis in patients on peritoneal dialysis is less common than bacterial peritonitis. Pooled data suggest an absolute incidence of 0.01 to 0.09 episodes per patient-year. […] The highest rates of fungal peritonitis have been reported in tropical countries, such as India and Thailand, and in Australia. Rates have been found to vary by season in such countries, with the highest rates associated with the wettest seasons. […] Fungi may contaminate the usually sterile peritoneum via the same pathways as bacteria.

• #15 Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

  https://www.wjgnet.com/1007-9327/full/v22/i34/7742.htm

  Spontaneous fungal peritonitis (SFP) is a complication of ESLD less known and described. The incidence accounts from 0% to 13% of patients with ESLD and spontaneous peritonitis. Data are conflicting regarding fungi distribution between nosocomial and non-nosocomial infections. […] SFP was more common in nosocomial SP and in patients with higher Child-Turcotte-Pugh (CTP). The most commonly fungus found was Candida spp. More than two-thirds of patients (11 patients, 73.3%) with fungal infection died within the first month after diagnosis of SP. […] In another retrospective study conducted in Korea, between January 1st 2003 and December 1st 2010, ninety-five ESLD patients with SP were included. Among the forty-seven pathogens isolated, one (2.2%) was a Candida spp. […] Distribution of fungi between HA-SFP vs CA-SFP was 12 vs 3, respectively.

• #16 Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

  https://www.wjgnet.com/1007-9327/full/v22/i34/7742.htm

  Fungal infections, Candida spp, were found in 10 patients (7.2%); C. albicans (3.6%) is the most frequent fungal infectious agent isolated. […] Patients with SFP had significantly higher mortality than the patients with SBP. […] Risk factors for hospital mortality in SFP are SBP antibacterial prophylaxis, hepatorenal syndrome, low protein ascites with total protein concentration of less than 1 g per deciliter, elevated APACHE II and serum lactate. […] The available data suggest that the SFP could affect negatively the prognosis of patients with SP, therefore new diagnostic and therapeutic strategies are required.

• #17 Peritonitis | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617300/all/Peritonitis?q=Metronidazole

  Rates of peritonitis vary based on the underlying abdominal processes but classically occurs in association with cirrhosis, nephrotic syndrome, and malignancy. […] In children on peritoneal dialysis, SBP incidence increases with duration, but majority suffer episode in first 6 months. […] Age may have inverse relationship on incidence rates: 0.79 peritoneal infections per year (in patients 1 year of age) versus 0.57 infections in children 12 years. […] In children with chronic liver disease-related ascites, prevalence of SBP ranges from 19% to 56%.

• #18

  https://link.springer.com/article/10.1007/s00467-017-3839-5

  Maintenance peritoneal dialysis (PD) is the dialysis modality of choice for infants and young children. […] Using data from the Childrens Hospital Associations Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (ESRD) Collaborative (SCOPE), we examined peritonitis rates and patient survival in 156 infants from 29 North American pediatric dialysis centers who had a chronic PD catheter placed prior to their first birthday. […] In-hospital and overall annualized rates of peritonitis were 1.73 and 0.76 episodes per patient-year, respectively. […] Multivariable regression models demonstrated that nephrectomy at or prior to PD catheter placement and G-tube insertion after catheter placement were associated with a nearly sixfold and nearly threefold increased risk of peritonitis, respectively.

• #19

  https://link.springer.com/article/10.1007/s00467-017-3839-5

  Infants with peritonitis had longer initial hospital stays and lower overall survival (86.3 vs. 95.6%, respectively; P 0.02) than those without an episode of peritonitis. […] In this large cohort of infants with ESRD, the frequency of peritonitis was high and several risk factors associated with the development of peritonitis were identified. […] Given that peritonitis was associated with a longer duration of initial hospitalization and increased mortality, increased attention to the potentially modifiable risk factors for infection is needed.

• #20 Changing epidemiology in spontaneous bacterial peritonitis and challenging balance between new strategies in empirical antibiotics and emergence of resistant bacteria – Lim – AME Medical Journal

  https://amj.amegroups.org/article/view/4389/html

  It has now been well described that bacterial infections are a common complication of liver cirrhosis and the most frequent precipitant of acute-on-chronic liver failure (ACLF). Spontaneous bacterial peritonitis (SBP) accounts for 25% of infections in these patients and carries significant mortality. A recent study has shown that inappropriate empirical antibiotic therapies for infection in ACLF actually increases 90-day mortality. However, there is also evidence that, over the years, improved timing and accuracy of the diagnosis of SBP as well as appropriate antibiotic therapy can reduce mortality from over 90% to 20%. […] Historically, SBP was a condition typically caused by Gram-negative bacteria and the literature in the 1990s widely reported a predominance of enteric organisms such as Escherichia coli and Klebsiella spp. accounting for around 80% of all cases of SBP. Since the turn of the millennium, however, there has been a growing awareness that the prevalence of GPB in liver cirrhosis has been on the increase, particularly in nosocomial infections. This is likely due to widespread use of prophylaxis with quinolones, increasing invasive procedures and admissions to critical care units. Concurrently, due to over-exposure to antibiotics, there has also been an alarming rise in the worldwide incidence of multi-drug resistant (MDR) organisms in recent years, the trend of which is also pervasive in the cirrhotic population. Recognised risk factors for development of MDR infections in cirrhotic population are nosocomial origin or health care contact, previous treatment with beta-lactams, long-term prophylaxis with quinolones and recent infection with MDR bacteria.

• #21 Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019 | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00528-1

  A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. […] We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. […] The aim of this pragmatic observational study was first to assess the frequency of MDROs in POP and its evolution over a two-decade period. […] Overall, 420/422 (99%) patients received EAT at the time of reoperation for POP. […] Adequacy was more frequently observed in combination therapies [261/344 (76%) vs. 44/76 (58%) monotherapies, respectively; p=0.048]. […] The theoretical adequacy of the 17 EAT therapeutic regimens is presented in Fig. 4. […] The only significant changes in the susceptibility profile of the isolates over the study period were a decreased susceptibility of Enterobacterales to piperacillin/tazobactam and cefotaxime (p=0.0005 and p<0.0001, respectively).

• #22 Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019 | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00528-1

  The adequacy of EAT was decreased for regimens involving both piperacillin/tazobactam monotherapy and combination, while the adequacy rate remained stable for carbapenems in combination with aminoglycosides or fluoroquinolones. […] This analysis of temporal trends for susceptibility of surgical specimens collected for POP indicates high and sustained proportions of MDROs involving 45% of the patients. […] The optimization of antibiotic therapy is a key issue. […] Piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO.

• #23 Study: Peritonitis Event Reporting with a Surveillance System – DaVita® Medical Insights

  https://blogs.davita.com/medical-insights/2019/09/10/study-peritonitis-event-reporting-surveillance-system/

  The ability to accurately and consistently identify peritonitis (PTN) events is necessary to make comparisons across and between peritoneal dialysis (PD) programs. This type of surveillance system also allows monitoring of efforts to reduce PTN rates. […] An analysis was then conducted to examine the impact of this surveillance system on the reporting of PTN events. […] By providing a consistent approach for the identification of PTN events, use of the surveillance system will allow accurate comparisons of rates between practices in the United States and across large dialysis organizations and different countries.

• #24

  https://link.springer.com/article/10.1007/s00467-010-1592-0

  Data on PD and peritonitis in pediatric patients in developing countries are scarce. […] In the study reported here, we evaluated the epidemiology of peritonitis in children on PD in Cape Town, South Africa and identified potential risk factors for peritonitis. […] Among our patients, socio-economic circumstances and quality of housing significantly influenced the peritonitis rate, and socio-economic circumstances also significantly influenced time to first peritonitis episode. […] The cumulative risk to develop peritonitis was even more elevated than that for the separate categories alone. […] Socio-economic risk factors have been investigated in only a few adult PD studies. […] In our study, the large majority of our patients were black or black mixed with other races, and no influence of race on peritonitis rate was found.

• #25 Clinical and microbiological aspects of fungal peritonitis in peritoneal dialysis | Nefrología

  https://revistanefrologia.com/en-clinical-microbiological-aspects-fungal-peritonitis-articulo-X2013251409033693

  Risk factors for developing fungal peritonitis have not been clearly determined. Numerous situations have been listed which play an important role in the appearance of the mycotic infection, including previous episodes of bacterial peritonitis and wide-spectrum antibiotic treatment. […] Advanced age has been cited on various occasions as a noteworthy trait in patients with fungal peritonitis. […] Some studies have shown a decrease in the bacterial peritonitis incidence rate with the new advances in peritoneal dialysis systems, the use of more biocompatible solutions, our better understanding of risk factors and the use of preventative measures, but there is no data regarding fungal infection.

• #25 Clinical and microbiological aspects of fungal peritonitis in peritoneal dialysis | Nefrología

  https://revistanefrologia.com/en-clinical-microbiological-aspects-fungal-peritonitis-articulo-X2013251409033693

  Peritonitis is one of the most serious complications of peritoneal dialysis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and a high mortality rate. Its incidence ranges from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. […] Fungal peritonitis in peritoneal dialysis is an infrequent complication. Its incidence rate is similar in automated peritoneal dialysis and continuous ambulatory peritoneal dialysis, although with the automated technique, the lower number of connections can reduce the episodes. […] Although fungal infection makes up about 4-10% of the peritonitis cases in children and 1-23% of those in adults according to the series, resulting in an average of 4-6% of all peritonitis episodes, it has a worse prognosis than a bacterial infection does.

• #26 Bacterial peritonitis in paediatric appendicitis; microbial epidemiology and antimicrobial management | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-023-00591-1

  A high proportion of children with appendicitis have Pseudomonas spp. isolated, leading to a prolonged LOS. Evolving Enterobacterales resistance and the presence of Pseudomonas spp. necessitate extended antibacterial coverage for paediatric appendectomies with evidence of peritonitis. […] The presence of pathogens was more commonly identified in patients who developed postoperative collections than those without (87.5% vs. 54.3%, p<0.01). [...] The role of intra-operative cultures in appendicectomies is widely debated. [...] The presence of a cultured pathogen may not accurately reflect the problem pathogen at time of appendectomy which limits this and other similar studies. [...] This study confirms that E. coli is the most commonly isolated pathogen from intra-operative cultures (42.0%), similar to other epidemiological studies (32-85%). [...] The clinical significance of intra-operative Pseudomonas spp. is not fully understood. [...] In our local practice, empiric antipseudomonal antimicrobial surgical prophylaxis is recommended (gentamicin) and as such may mitigate against some of the possible Pseudomonas spp. complications.

• #27 Peritonitis – Epidemiology and Management at A Rural Hospital in Zambia

  https://www.annalsofafricansurgery.com/peritonitis-in-rural-zambia

  Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia […] Abstract […] Background: Peritonitis is a common surgical emergency with varying etiologies encountered the world over. It is associated with significant morbidity and mortality despite intensive research and advances in management. […] This study, therefore, aimed to evaluate the etiology of peritonitis among the rural population of Zambia and to assess risk factors leading to lethal outcome. Findings could be of value for rural surgeons facing the dilemma of operating patients immediately, or referring them to the tertiary center for further management. […] Peritonitis is a commonly seen surgical emergency on the African continent as well as in other countries. In this study, the principal etiological factors leading to the development of peritonitis were perforation of peptic ulcer (22.7%), acute appendicitis (21.9%), PID (18.5%) and spontaneous perforation of the small bowel (13.5%). […] The study emphasizes the significance of organ failure for fatal outcome in peritonitis. Patients with short history and without signs of organ failure could be successfully treated in low-volume rural surgical hospitals that have an uninterrupted access to the operating theatre. MPI is a highly useful and informative tool for predicting patient outcome.

• #28

  https://www.ajol.info/index.php/aas/article/view/199725

  Peritonitis is a common surgical emergency with varying etiologies encountered the world over. It is associated with significant morbidity and mortality despite intensive research and advances in management. […] Common sources of peritonitis were perforated peptic ulcer, acute appendicitis, pelvic inflammatory disease, and perforated terminal ileum. […] Fourteen patients (11.8%) died postoperatively; the highest level of mortality was in patients with perforated peptic ulcer (26%). […] Individual approach with identifying signs of organ failure is essential to determine the patients prognosis and decide on the level of care.

• #29 Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit | Scientific Reports

  https://www.nature.com/articles/s41598-021-85443-8

  The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. […] Intra-abdominal infections (IAIs) are one of the main causes of postoperative infections leading to ICU admission and are associated with high mortality rates. […] The only published data have shown staphylococci-positive peritoneal cultures ranging from 7% up to 22% of patients. […] The prevalence of staphylococci was similar in both community- and hospital-acquired IAIs. […] As a result, the pathogenicity of staphylococci remains debated in IAIs, as well as the need for antibiotic therapy, especially for CoNS. […] The objective of this study was to compare the epidemiological, clinical, microbiological and prognostic characteristics of patients admitted to the ICU for hospital-acquired postoperative intra-abdominal infections (HAIs) according to the presence or absence of staphylococci in their peritoneal cultures.

• #30 Microbiological Surveillance and Antimicrobial Susceptibility Observations on Peritoneal Dialysis-Associated Peritonitis in an Outpatient German Reference Center

  https://www.mdpi.com/2036-7449/17/3/49

  Microbiological Surveillance and Antimicrobial Susceptibility Observations on Peritoneal Dialysis-Associated Peritonitis in an Outpatient German Reference Center […] Background: Peritonitis is a relevant complication in peritoneal dialysis (PD). The initial empirical antibiotic therapy depends on the center-specific distribution of microorganisms and the microbial susceptibility profiles. However, data on the locoregional germ spectrum in Germany are insufficient regarding the current recommended empirical antibiotic regimens of either cefepime as monotherapy or the combination of cefazolin and ceftazidime. […] Methods: This retrospective single-center study of routine clinical patient data analyzes the range of infecting organisms causing PD-associated peritonitis and their corresponding antimicrobial resistances during the 2015 to 2022 timeframe. We used Ordinary Least-Squares regression to model trends in the detection of microbiological spectrum samples. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD) statement was acknowledged.

• #31 Microbiological Surveillance and Antimicrobial Susceptibility Observations on Peritoneal Dialysis-Associated Peritonitis in an Outpatient German Reference Center

  https://www.mdpi.com/2036-7449/17/3/49

  Results: There were 80 documented peritonitis episodes with 99 causal etiologies sampled. Of those, eighty-seven were bacterial, three were fungi (3%), eight had no microbial growth (8%), and one more had missing data. The largest group of microorganisms detected were Gram-positive bacteria (N = 56, 56.6%), predominantly sampled as Staphylococcacea, Enterococcaceae, and Streptococcaceae (Staphylococcus aureus, 14.1%). Gram-negative bacteria were found in 31.3% of samples (N = 31), predominantly Enterobacteriaceae (Escherichia coli, 9%). In total, 34 different microorganisms were identified. On one occasion, methicillin-resistant Staphylococcus epidermidis and one sample of multi-resistant Serratia marcescens were identified. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were not detected. Fungi were found in three peritonitis episodes. Regression analyses did not indicate changes in the general microbiological spectrum during the observational timeframe. The center-specific peritonitis rates were below the recommended rates of the International Society for Peritoneal Dialysis for all years studied.

• #32 Microbiology and therapy of peritonitis in peritoneal dialysis – UpToDate

  https://www.uptodate.com/contents/microbiology-and-therapy-of-peritonitis-in-peritoneal-dialysis

  Peritonitis is one of the major complications of peritoneal dialysis and remains the primary reason that patients switch from peritoneal dialysis to hemodialysis. This topic reviews the microbiology and therapy of peritonitis in peritoneal dialysis. Risk factors, prevention, and the approach to the diagnosis of peritonitis, including exclusion of other intra-abdominal diseases, are discussed separately: […] The vast majority of peritonitis cases are caused by bacteria. Approximately 3 to 5 percent are caused by fungi, mostly Candida spp. A viral etiology of peritonitis has been postulated in some cases, although viral infection as a cause of peritonitis has not been proven conclusively. Approximately 45 to 65 percent of cases are caused by gram-positive organisms and 15 to 35 percent by gram-negative organisms. More than one organism has been reported in 1 to 4 percent of cases.

• #33 Feline infectious peritonitis: insights into feline coronavirus pathobiogenesis and epidemiology based on genetic analysis of the viral 3c gene | Microbiology Society

  https://www.microbiologyresearch.org/content/journal/jgv/10.1099/vir.0.016485-0

  Feline infectious peritonitis (FIP) is a lethal systemic disease caused by FIP virus (FIPV), a virulent mutant of apathogenic feline enteric coronavirus (FECV). […] Our findings suggest that functional 3c protein expression is crucial for FECV replication in the gut, but dispensable for systemic FIPV replication. […] Most cats with FIP had no detectable intestinal feline coronaviruses (FCoVs) and had seemingly cleared the primary FECV infection. […] Apparently, 3c-inactivated viruses replicate not at all or only poorly in the gut, explaining the rare incidence of FIP outbreaks. […] Feline infectious peritonitis viruses arise by mutation from endemic feline enteric coronaviruses.

• #34 Feline Infectious Peritonitis – Infectious Diseases – Merck Veterinary Manual

  https://www.merckvetmanual.com/generalized-conditions/feline-infectious-peritonitis/feline-infectious-peritonitis

  Any cat that carries FCoV is potentially at risk of developing FIP; however, several additional risk factors have been identified: group housing in multicat environments, young ( 10 years old) ages, sexually intact neuter status, male sex, purebred lineage (including Abyssinian, Bengal, Birman, Himalayan, Ragdoll, and Rex [Cornish and Devon varieties]), recent stress (eg, rehoming, elective surgery, concurrent illness, boarding), retroviral infection. […] The incubation period for FIP is variable, ranging from days or weeks to months or years. […] FIP is estimated to cause the death of 0.3%1.4% of all cats examined at veterinary institutions worldwide. […] Both domestic and wild Felidae, particularly cheetahs, but also bobcats, caracals, cougars, jaguars, leopards, lions, lynx, sand cats, and servals are susceptible to FCoV infection and the development of FIP. […] FCoV infection is not considered a zoonotic risk.

• #35 Insights on feline infectious peritonitis risk factors and sampling strategies from polymerase chain reaction analysis of feline coronavirus in large-scale nationwide submissions in: Journal of the American Veterinary Medical Association Volume 263 Issue

  https://avmajournals.avma.org/view/journals/javma/263/1/javma.24.03.0208.xml

  This nationwide study aimed to investigate risk factors associated with FIP and determine optimal sample submission strategies for its diagnosis. […] Understanding the risk factors and optimizing sample selection for FIP diagnosis can aid in the early detection and management of the disease, ultimately improving outcomes for affected cats. These findings contribute valuable insights to FIP epidemiology and underscore the importance of continued research to enhance diagnostic strategies and disease management approaches. […] Studies investigating the epidemiology of FIP in cats have identified risk factors for the development of FIP such as age, breed, sex, seasons, coinfection, and multicat environments. All these identified risk factors play a crucial role in guiding diagnostic strategies, therapy, and disease control strategies.

• #36 Insights on feline infectious peritonitis risk factors and sampling strategies from polymerase chain reaction analysis of feline coronavirus in large-scale nationwide submissions in: Journal of the American Veterinary Medical Association Volume 263 Issue

  https://avmajournals.avma.org/view/journals/javma/263/1/javma.24.03.0208.xml

  The study identified significant risk factors associated with FIP. Optimal sample submission strategies, particularly emphasizing the use of peritoneal fluid, kidney, and lymph node, were identified to improve FIP detection rates. Urine yielded a relatively high frequency of infection and viral loads compared with most other samples. […] The data from this nationwide study, comprising 14,035 clinical sample submissions for FIP diagnosis, reaffirmed the findings of previous studies and shed novel insights into associated risk factors and optimal choice of sample selection for diagnosis. […] Our findings highlighted that young cats aged 0 to 1 year exhibit a greater likelihood of testing positive for FCoV, potentially due to stressors and immature immune systems. Additionally, similar to COVID-19 in humans, male cats appear to have a higher positivity of FCoV detection, suggesting a gender predisposition. Purebred cats, especially British Shorthairs, show increased susceptibility to FCoV infection, emphasizing the importance of genetic factors. Detection of FCoV in tissues such as peritoneal fluid, urine, kidney, and lymph node proved valuable in our study, potentially aiding in diagnosis. However, limitations such as the lack of confirmed FIP diagnoses and the need for further validation of detection methods underscored the necessity for continued research. Overall, this study contributes to our understanding of FIP epidemiology and underscores the need for improved diagnostic strategies and management approaches.

• #37 Group A Streptococcus Primary Peritonitis in Children, New Zealand – Volume 29, Number 11—November 2023 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/29/11/23-0211_article

  Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. […] As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen. […] In late 2022, the United Kingdom, United States, Australia, and several countries in Europe reported unexpectedly high rates of iGAS and scarlet fever, particularly in children 10 years of age. […] In New Zealand, iGAS disease is not notifiable to Public Health authorities. Surveillance relies on individual laboratories sending clinically relevant iGAS isolates to the Institute of Environmental Science and Research (ESR) for typing.

• #38 Group A Streptococcus Primary Peritonitis in Children, New Zealand – Volume 29, Number 11—November 2023 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/29/11/23-0211_article

  The most recent ESR report (2016) describes an iGAS incidence of 9.0/100,000 population in New Zealand; rates were inequitably high among New Zealand Mori (23.5/100,000 population) and Pacific peoples (73.9/100,000 population) compared with rates among persons of European or other ethnicities (4.3/100,000 population). […] Although ESR laboratory surveillance provides some information on the burden of iGAS in New Zealand, its passive nature suggests that reported rates are likely to be an underestimate. […] This case series highlights the difficulties of case ascertainment, disease surveillance, and the ability to monitor circulating emm-types when a disease is not monitored through prospective national surveillance. […] In a time of increasing global rates of iGAS disease, the results of this study strengthen calls for enhanced, prospective, national iGAS surveillance.

• #39 Changing epidemiology in spontaneous bacterial peritonitis and challenging balance between new strategies in empirical antibiotics and emergence of resistant bacteria – Lim – AME Medical Journal

  https://amj.amegroups.org/article/view/4389/html

  It is in this context that Fiore et al, have sought to illustrate a) that there has been an epidemiological change in the profile of causative bacteria of SBP since 2000, specifically towards GPB and MDR, and b) that there is thus a need to update our empiric antibiotic guidelines accordingly. […] Fiore et al review adds further weight to the emerging worldwide trend towards high frequency of GPB in SBP and the rise in MDR, particularly in nosocomial SBP. A change in antimicrobial practice to reflect this is necessary for optimisation of both antimicrobial stewardship and patient outcomes. Thus, new strategies of empirical antibiotic treatment should be tailored according to the local patterns of antibiotic resistance. MDR pathogens differ hugely not only between different countries but also between different areas within the same country.

• #40 Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135969

  The current rise in 3GCR-GN indicated the need of a carbapenem antibiotic regimen in the treatment of PD-associated peritonitis. The ISPD outlines the importance of a surveillance program in each PD center to adapt the empiric therapy to the local resistance spectrum. As a consequence of our local antimicrobial surveillance we changed the empiric therapy in PD patients with peritonitis from cefazolin i.p. and gentamycin i.p. to vancomycin i.p. and gentamycin i.p. in 2014. […] Our data suggests that it is necessary to implement local antibiotic stewardship strategies in PD programs.

• #41 Microbiological Surveillance and Antimicrobial Susceptibility Observations on Peritoneal Dialysis-Associated Peritonitis in an Outpatient German Reference Center

  https://www.mdpi.com/2036-7449/17/3/49

  Conclusions: The recommended empiric therapy was suitable at our center, with a few exceptions for non-specific pathogens and for those with β-lactamases or enterococci. When there is no clinical response to empiric therapy, alternative antibiotics should be considered accordingly. The retrospective data are limited to the reported outcome measures.

• #42 (PDF) Epidemiology of peritonitis

  https://www.academia.edu/51824217/Epidemiology_of_peritonitis

  The most relevant epidemiological data concerning different form of peritonitis are reviewed taking into account that secondary peritonitis are those of major interest for surgeons. […] A review of the literature concerning the epidemiology of peritonitis secondary to peptic ulcer perforation, appendicitis, hollow viscus perforation after endoscopic procedures, colonic perforation and postoperative peritonitis is given. […] Some details about primary peritonitis and peritonitis occurring in AIDS patients are discussed as well. […] Diffuse peritonitis secondary to appendiceal perforation results in a mortality rate of 4.5% for patients age 51 to 70 and 15% for those over age 70. […] Peritonitis secondary to gut perforation or to other sources of infection should be considered because one disease process doesn’t exclude another.

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