Materiały źródłowe

• #1 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The management approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure. Treatment success is defined as adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection. […] Early control of the septic source is mandatory and can be achieved by operative and nonoperative means. […] Nonoperative interventions include percutaneous abscess drainage, as well as percutaneous and endoscopic stent placements. If an abscess is accessible for percutaneous drainage and if the underlying visceral organ pathology does not clearly require operative intervention, percutaneous drainage is a safe and effective initial treatment approach.

• #2 Peritonitis: Symptoms, Causes, Treatments, and More

  https://www.healthline.com/health/peritonitis

  Peritonitis is a serious condition that requires immediate medical attention. The infection can spread and become life threatening if it isnt treated promptly. […] The first step in treating peritonitis is determining its underlying cause. Treatment usually involves medication for pain. Prompt intravenous (IV) antibiotics are needed to treat a bacterial infection. […] If you have an intestinal infection, an abdominal abscess, or a ruptured appendix, you may need surgery to remove the infected tissue. […] Your treatment must begin promptly to avoid serious and potentially fatal complications. […] If you have peritonitis, your outlook will depend on the cause of your infection and how far it progressed before treatment began. Medications and surgery are usually able to treat the infection.

• #2 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The treatment of peritonitis is multidisciplinary, with complementary application of medical, operative, and nonoperative interventions. Medical support includes the following: systemic antibiotic therapy, intensive care with hemodynamic, pulmonary, and renal support, nutrition and metabolic support, inflammatory response modulation therapy. […] Treatment of peritonitis and intra-abdominal sepsis always begins with volume resuscitation, correction of potential electrolyte and coagulation abnormalities, and empiric broad-spectrum parenteral antibiotic coverage. […] Antibiotic therapy is used to prevent local and hematogenous spread of infection and to reduce late complications. […] Several different antibiotic regimens are available for the treatment of intra-abdominal infections. […] The optimal duration of antibiotic therapy must be individualized and depends on the underlying pathology, severity of infection, speed and effectiveness of source control, and patient response to therapy.

• #3 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  There is no controversy regarding the standard treatment that includes control of the source and intra-abdominal lavage (washing); however, in patients who have advanced peritonitis, the source of the infection may not be completely eradicated with a single operation. Thus controversy arises, specifically regarding issues such as time and frequency of repetitive laparotomies, and management of the open wound/abdomen. Furthermore, the aggressive resuscitation required in these patients causes gut and abdominal wall edema that may be associated with increased intra-abdominal pressure, worsened by a premature closing of the abdominal wall. To date, it is clear that the reduction of mortality below 20% has been the result of a better understanding of the role of damage control, prevention of intra-abdominal compartment syndrome, and improved antibiotic alternatives with broad-spectrum newer medications. […]

• #4 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Peritoneal infections are classified as primary, secondary, or tertiary. Primary peritoneal infections arise from hematogenous dissemination, usually in the setting of an immunocompromised state, while secondary infections are related to a pathologic process in an abdominal organ, such as perforation, ischemia and gangrene, trauma, or a postoperative problem, such as anastomotic leak. Tertiary peritoneal infection is a persistent or recurrent infection that exists after an adequate initial therapy for secondary peritonitis. […] Antibiotic therapy is used to prevent local and hematogenous spread of an intra-abdominal infection and to reduce late complications. […] Several different antibiotic regimens are available for the treatment of intra-abdominal infections. […] Single-agent, broad-spectrum therapy and combination therapies have been used against these infections, although no specific therapy has been found to be superior to another.

• #5 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  Class I recommendations regarding empiric antibiotic selection for peritonitis by the International Society for Peritoneal Dialysis (ISPD) include initiating antibiotic therapy as soon as possible, either intraperitoneally or systemically, after obtaining appropriate microbiologic specimens. […] Drainage refers to evacuation of an abscess. This can be performed operatively or percutaneously under ultrasound or CT guidance. […] In some instances, success of nonoperative drainage also includes the ability to delay surgery until the acute process and sepsis are resolved and a definitive procedure can be performed under elective circumstances. […] Nutritional demands increase during sepsis, with caloric requirements of 25-35 kcal/kg/d. Patients with sepsis should be fed a high-protein isocaloric diet. […] The treatment of intra-abdominal sepsis requires a multidisciplinary approach. In the treatment of secondary peritonitis, a surgeon must be consulted.

• #6 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Usually, in patients with intra-abdominal infection who have been treated with proper source control and prompt surgical intervention, antibacterial therapy is given for 5-7 days, but this regimen may need to be extended, depending on the clinical situation. […] Antibiotics can be discontinued once the clinical signs of infection (eg, fever, tachycardia, leukocytosis) have resolved. Recurrence is a concern with certain infections, such as those with Candida and Staphylococcus aureus, and treatment should be continued for 2-3 weeks. […] Class I recommendations regarding empiric antibiotic selection for peritonitis by the International Society for Peritoneal Dialysis (ISPD) include initiating antibiotic therapy as soon as possible, either intraperitoneally or systemically, after obtaining appropriate microbiologic specimens; using center-specific antibiotic regimens to cover gram-positive and gram-negative organisms; and using a first-generation cephalosporin or vancomycin to cover gram-positive organisms, whereas a third-generation cephalosporin or an aminoglycoside should be used to cover gram-negative organisms.

• #7 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Infection of the abdominal cavity requires coverage for gram-negative and gram-positive bacteria, as well as for anaerobes. Antipseudomonal coverage is recommended for patients who have had previous treatment with antibiotics or who have had a prolonged hospitalization or any intervention. […] In case of severe infections with features of systemic sepsis, a policy of „hit early and hit hard” (starting therapy as soon as infection is suspected with broad spectrum antibiotics) reduces the mortality of infection. […] Choice of antibiotics largely depends on whether the infection is community acquired or hospital acquired (nosocomial), the local spectrum of organisms grown and their sensitivity to antibiotics (antibiogram) in similar patients in the near past, costs and side effects of the antibiotics, and comorbidities (especially renal and liver dysfunction) in the patient.

• #8 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Peritoneal infections are classified as primary, secondary, or tertiary. Primary peritoneal infections arise from hematogenous dissemination, usually in the setting of an immunocompromised state, while secondary infections are related to a pathologic process in an abdominal organ, such as perforation, ischemia and gangrene, trauma, or a postoperative problem, such as anastomotic leak. Tertiary peritoneal infection is a persistent or recurrent infection that exists after an adequate initial therapy for secondary peritonitis. […] Antibiotic therapy is used to prevent local and hematogenous spread of an intra-abdominal infection and to reduce late complications. […] Several different antibiotic regimens are available for the treatment of intra-abdominal infections. […] Single-agent, broad-spectrum therapy and combination therapies have been used against these infections, although no specific therapy has been found to be superior to another.

• #9 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Usually, in patients with intra-abdominal infection who have been treated with proper source control and prompt surgical intervention, antibacterial therapy is given for 5-7 days, but this regimen may need to be extended, depending on the clinical situation. […] Antibiotics can be discontinued once the clinical signs of infection (eg, fever, tachycardia, leukocytosis) have resolved. Recurrence is a concern with certain infections, such as those with Candida and Staphylococcus aureus, and treatment should be continued for 2-3 weeks. […] Class I recommendations regarding empiric antibiotic selection for peritonitis by the International Society for Peritoneal Dialysis (ISPD) include initiating antibiotic therapy as soon as possible, either intraperitoneally or systemically, after obtaining appropriate microbiologic specimens; using center-specific antibiotic regimens to cover gram-positive and gram-negative organisms; and using a first-generation cephalosporin or vancomycin to cover gram-positive organisms, whereas a third-generation cephalosporin or an aminoglycoside should be used to cover gram-negative organisms.

• #10 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  In secondary peritonitis, systemic antibiotic therapy is the second mainstay of treatment following source control (eg, removal of appendix, closure of perforation, resection of gangrenous bowel, drainage of abscess). […] Several studies suggest that antibiotic therapy is not as effective in the later stages of infection and that early (preoperative) systemic antibiotic therapy can significantly reduce the concentration and growth rates of viable bacteria in the peritoneal fluid. […] Antibiotic therapy begins with empiric coverage (effective against common gram-negative and anaerobic pathogens), which should be initiated as soon as possible, with a transition made to narrower-spectrum agents (step down approach) as culture results become available. […] Tertiary peritonitis is persistent, residual, or recurrent peritoneal infection after adequate source control and antibiotic therapy of secondary peritonitis.

• #11 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Treatment is largely with antibiotics and antifungals; nonsurgical intervention in the form of image-guided percutaneous catheter drainage may be required if there are any collections. […] Antibiotic therapy appears to be less effective in tertiary peritonitis than in other forms of peritonitis. […] The optimal duration of antibiotic therapy must be individualized and depends on the underlying pathology, severity of infection, speed and effectiveness of source control, and patient response to therapy. […] In uncomplicated peritonitis in which there is early, adequate source control, a course of 5-7 days of antibiotic therapy is adequate in most cases. […] Inadequate initial therapy has been linked to worse outcomes, and these outcomes could not be significantly changed by later specific or prolonged therapy.

• #12 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Treatment is largely with antibiotics and antifungals; nonsurgical intervention in the form of image-guided percutaneous catheter drainage may be required if there are any collections. […] Antibiotic therapy appears to be less effective in tertiary peritonitis than in other forms of peritonitis. […] The optimal duration of antibiotic therapy must be individualized and depends on the underlying pathology, severity of infection, speed and effectiveness of source control, and patient response to therapy. […] In uncomplicated peritonitis in which there is early, adequate source control, a course of 5-7 days of antibiotic therapy is adequate in most cases. […] Inadequate initial therapy has been linked to worse outcomes, and these outcomes could not be significantly changed by later specific or prolonged therapy.

• #13 What Is Antibiotic Therapy for Peritonitis?

  https://www.icliniq.com/articles/gastro-health/antibiotic-therapy-for-peritonitis

  Antibiotic therapy is commonly used in cases of infection and sepsis, and they are sufficient in eliminating pathogens causing surgical sepsis. Regimens with less or no gram-negative activity rods or anaerobic gram-negative are not considered. […] Antibiotic therapy is usually recommended for five to seven days in generalized peritonitis. The recommended duration of antimicrobial therapy in postoperative peritonitis should be no longer than seven days. […] In most cases of peritonitis, antibiotic therapy gives symptomatic relief. Due to the underlying bacterial contamination, surgery combined with lavage with a course of antibiotics is recommended. Tertiary peritonitis is often attributed to antibiotic-resistant bacteria that are not affected by the first line of antibiotics. In such cases, stronger-acting antibiotics are used for treatment, and individuals may have to undergo laparoscopy for proper diagnosis of the root cause of the infection.

• #14 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Antimicrobial therapy should continue until signs of infection (eg, fever, tachycardia, leukocytosis) have resolved; if signs of infection continue, persistent infection or the presence of a nosocomial infection should be investigated. […] Antibiotics alone are seldom sufficient to treat intra-abdominal abscesses, and adequate drainage (image-guided percutaneous catheter drainage or surgical drainage) of the abscess is of paramount importance.

• #15 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The management approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure. Treatment success is defined as adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection. […] Early control of the septic source is mandatory and can be achieved by operative and nonoperative means. […] Nonoperative interventions include percutaneous abscess drainage, as well as percutaneous and endoscopic stent placements. If an abscess is accessible for percutaneous drainage and if the underlying visceral organ pathology does not clearly require operative intervention, percutaneous drainage is a safe and effective initial treatment approach.

• #16 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  Spontaneous bacterial peritonitis can be life-threatening. You’ll need to stay in the hospital. Treatment includes antibiotics. It also includes supportive care to ease your symptoms. […] You’ll also need to stay in the hospital for secondary peritonitis. Treatment may include: […] Antibiotics. You’ll likely take antibiotic medicine through a needle in a vein. This clears out the infection and keeps it from spreading. The type of antibiotic you’ll need and how long you’ll have to take it will vary. It depends on how serious your condition is and the kind of peritonitis you have. […] Surgery. This is often needed to remove infected tissue, treat the cause of the infection, and prevent the infection from spreading. Surgery is important if your peritonitis is due to a ruptured appendix, stomach or colon.

• #17 Updated Guideline on Diagnosis and Treatment of Intra-abdominal Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0915/p694.html

  Intra-abdominal infections are the second most common cause of infectious mortality in intensive care units. Complicated intra-abdominal infection, which extends into the peritoneal space, is associated with abscess formation and peritonitis. Treatment of intra-abdominal infections has evolved in recent years because of advances in supportive care, diagnostic imaging, minimally invasive intervention, and antimicrobial therapy. […] A source control procedure to drain infected foci, control ongoing peritoneal contamination, and restore anatomic and physiologic function is recommended in virtually all patients with intra-abdominal infection. Emergency surgery should be performed in patients with diffuse peritonitis, even if measures to restore physiologic stability must be continued during the procedure.

• #18 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  The goals of surgical treatment are eliminating the cause of the contamination, reducing the bacterial inoculum, and preventing persistent or recurrent sepsis. The surgical approach is best made via a midline incision to ensure adequate and complete exploration of the abdominal cavity. Diligent hemostasis and thorough exploration are of primary importance. Suctioning of all fluid cavities is done and quantified. Samples are taken for Gram’s stain fungal studies and culture. In general terms, control is achieved by excluding or resecting the perforated viscera. […]

• #19 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  The terms peritonitis, intra-abdominal infection, and abdominal sepsis are not synonymous, yet sometimes they are used indistinctly to define similar clinical states. Peritonitis is defined as an inflammatory process of the peritoneum caused by any irritant/agent such as bacteria, fungi, virus, talc, drugs, granulomas, and foreign bodies. Intra-abdominal infection is defined as the local manifestations that occur as a consequence of peritonitis. Intra-abdominal sepsis entails a systemic manifestation of a severe peritoneal inflammation. […] […] The mortality of an intra-peritoneal infection in the early 1900s was close to 90%. This condition was managed nonoperatively until Kishner introduced the basic principles of surgery in intra-abdominal infections: (1) elimination of the septic foci, (2) removal of necrotic tissue, and (3) drainage of purulent material. By the 1930s, mortality had been reduced to 50%. With the introduction of antibiotics, the mortality continued to decrease slowly. The use of cephalosporins by the early 1970s was associated with a reduction of mortality to less than 30% to 40%. Subsequent advances in the understanding of physiology, the monitoring and support of the cardiopulmonary systems, the rational use of new drugs, and ICU care aided in stabilizing mortality at around 30%. […]

• #20 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  There is no controversy regarding the standard treatment that includes control of the source and intra-abdominal lavage (washing); however, in patients who have advanced peritonitis, the source of the infection may not be completely eradicated with a single operation. Thus controversy arises, specifically regarding issues such as time and frequency of repetitive laparotomies, and management of the open wound/abdomen. Furthermore, the aggressive resuscitation required in these patients causes gut and abdominal wall edema that may be associated with increased intra-abdominal pressure, worsened by a premature closing of the abdominal wall. To date, it is clear that the reduction of mortality below 20% has been the result of a better understanding of the role of damage control, prevention of intra-abdominal compartment syndrome, and improved antibiotic alternatives with broad-spectrum newer medications. […]

• #21 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The management approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure. Treatment success is defined as adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection. […] Early control of the septic source is mandatory and can be achieved by operative and nonoperative means. […] Nonoperative interventions include percutaneous abscess drainage, as well as percutaneous and endoscopic stent placements. If an abscess is accessible for percutaneous drainage and if the underlying visceral organ pathology does not clearly require operative intervention, percutaneous drainage is a safe and effective initial treatment approach.

• #22 Antibiotic Therapy for Peritonitis: Treatment Overview, Spontaneous Bacterial Peritonitis, Secondary and Tertiary Peritonitis

  https://emedicine.medscape.com/article/1926162-overview

  Antimicrobial therapy should continue until signs of infection (eg, fever, tachycardia, leukocytosis) have resolved; if signs of infection continue, persistent infection or the presence of a nosocomial infection should be investigated. […] Antibiotics alone are seldom sufficient to treat intra-abdominal abscesses, and adequate drainage (image-guided percutaneous catheter drainage or surgical drainage) of the abscess is of paramount importance.

• #23 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The treatment of peritonitis is multidisciplinary, with complementary application of medical, operative, and nonoperative interventions. Medical support includes the following: systemic antibiotic therapy, intensive care with hemodynamic, pulmonary, and renal support, nutrition and metabolic support, inflammatory response modulation therapy. […] Treatment of peritonitis and intra-abdominal sepsis always begins with volume resuscitation, correction of potential electrolyte and coagulation abnormalities, and empiric broad-spectrum parenteral antibiotic coverage. […] Antibiotic therapy is used to prevent local and hematogenous spread of infection and to reduce late complications. […] Several different antibiotic regimens are available for the treatment of intra-abdominal infections. […] The optimal duration of antibiotic therapy must be individualized and depends on the underlying pathology, severity of infection, speed and effectiveness of source control, and patient response to therapy.

• #24 Acute Bacterial Peritonitis in Adults

  https://www.uspharmacist.com/article/acute-bacterial-peritonitis-in-adults

  Secondary peritonitis requires surgical treatment, known as source control, to correct the underlying pathology. Source control intends to correct anatomical derangements, remove infectious foci, and control the factors promoting ongoing infection. […] Hypovolemia in the setting of peritonitis can lead to organ failure. Therefore, regardless of the presence of septic shock, rapid fluid resuscitation is warranted in all patients with peritonitis in order to promote physiological stability. […] Empirical antibiotic therapy should be initiated upon suspicion of peritonitis. Practice guidelines from the Infectious Diseases Society of America (IDSA) recommend that empiric antimicrobial therapy be initiated within the first hour of the recognition of peritonitis in patients with compromised hemodynamic or organ function; otherwise, therapy should be initiated within 8 hours of presentation.

• #25 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  Class I recommendations regarding empiric antibiotic selection for peritonitis by the International Society for Peritoneal Dialysis (ISPD) include initiating antibiotic therapy as soon as possible, either intraperitoneally or systemically, after obtaining appropriate microbiologic specimens. […] Drainage refers to evacuation of an abscess. This can be performed operatively or percutaneously under ultrasound or CT guidance. […] In some instances, success of nonoperative drainage also includes the ability to delay surgery until the acute process and sepsis are resolved and a definitive procedure can be performed under elective circumstances. […] Nutritional demands increase during sepsis, with caloric requirements of 25-35 kcal/kg/d. Patients with sepsis should be fed a high-protein isocaloric diet. […] The treatment of intra-abdominal sepsis requires a multidisciplinary approach. In the treatment of secondary peritonitis, a surgeon must be consulted.

• #26 Peritonitis in Animals – Digestive System – Merck Veterinary Manual

  https://www.merckvetmanual.com/digestive-system/peritonitis/peritonitis-in-animals

  Peritonitis is inflammation of the serous membranes of the peritoneal cavity. […] Treatment includes peritoneal lavage, surgery, antimicrobials, and anti-inflammatory medications. […] Adequate treatment for peritonitis depends on the diagnosis and the results of both physical examination and laboratory analyses. […] In severe cases of septic peritonitis, initial treatment must be directed at saving the life of the patient and stabilizing cardiovascular and other organ functions. […] Treatment with appropriate antimicrobials should be started once septic peritonitis is suspected or confirmed. […] If possible, treatment should be initiated to eliminate the cause of peritonitis. […] In both small and large animals, placement of abdominal drains and subsequent lavage can help treat severe peritonitis by removing septic and proinflammatory material from the abdominal cavity. […] Nutritional support should be anticipated, because many patients with peritonitis will not eat. […] In chronic adhesive peritonitis, laparoscopy or laparotomy can be considered to cut adhesions that prevent intestinal motility or to remove or drain intestinal abscesses.

• #27 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  Other treatments. Depending on your symptoms, your treatment while in the hospital will likely include: Pain medications. Fluids given through a tube, called intravenous fluids. Oxygen. In some cases, a blood transfusion. […] If you have peritonitis, your health care provider may suggest that you receive dialysis in another way. You may need this other type of dialysis for several days while your body heals from the infection. If your peritonitis lingers or comes back, you may need to stop having peritoneal dialysis completely and switch to a different type of dialysis.

• #28

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7186812/

  Primary (spontaneous bacterial) peritonitis (SBP) affects only about 1% of all peritonitis cases. In adults, predominantly patients with ascites through alcoholic liver cirrhosis are affected or patients with a reduced immune status from another cause. Mostly it is a mono-infection. In realistic studies, it is only possible to detect pathogens in about 35% of cases, with Escherichia coli, Klebsiella spp., Staphylococci, enterococci or streptococci, and occasionally pathogenic gastroenteritis pathogens such as Aeromonas spp. or Salmonella spp. being detected. […] Randomized studies on the treatment of SBP are rare. Most of them are retrospective studies. Substances used were ceftriaxone, cefotaxime, ceftazidime, ampicillin/sulbactam, ampicillin + tobramycin and amoxycillin/clavulanic acid. Using these alongside administration of albumin, clinical cure rates of about 80% were achieved.

• #29 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Therefore, third-generation cephalosporins, such as cefotaxime (2 grams every 8 hours for 5 days) and ceftriaxone (1 gram every 12 hours or 2 grams every 24 hours for 5 days), are the first-line agents for empirical treatment of community-acquired SBP. […] In a randomized, controlled study involving persons with cirrhosis and SBP, the use of intravenous albumin (1.5 g/kg given within 6 hours of enrollment and repeated as a 1.0 g/kg dose on day 3) as an adjunctive to cefotaxime was shown to decrease in-hospital mortality when compared with use of cefotaxime alone (29% versus 10%). […] Due to increasing failures of initial antibiotic therapy, follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. […] If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered.

• #30

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7186812/

  CAPD peritonitis is usually caused by contamination of the tubing or catheter system. Uncomplicated cases can be treated locally by adding antimicrobial substances to the dialysis fluid. In addition to intraperitoneal treatment, parenteral treatment also becomes necessary in the rarer severe forms. Cefotaxime, cefuroxime or ceftriaxone (in monotherapy or in combination with ciprofloxacin) is recommended for calculated treatment. […] Secondary peritonitis, with perforation of the gastrointestinal tract, is by far the most common IAI, at around 80-90%. By definition, surgical source control must be carried out (infectious source rehabilitation, for example appendectomy for perforated appendicitis) or interventional treatment. In terms of a three-pillar model, diffuse peritonitis requires surgical, antimicrobial and intensive care treatment.

• #31

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7186812/

  In community-acquired secondary peritonitis there is always a mixed infection. The pathogen spectrum derives from the flora of the gastrointestinal tract and is dependent on the pathogenesis and the location of the perforation or leakage. Key pathogens are Escherichia coli, Bacteroides fragilis, Enterococci and Candida spp. For antibiotic treatment of localized acute peritonitis, cefuroxime, cefotaxime, ceftriaxone or ciprofloxacin, in combination with metronidazole, as well as ampicillin/sulbactam or amoxicillin/clavulanic acid can be used. […] For the treatment of diffuse peritonitis, which persists for more than 24 hours, substances or combinations with a broad action spectrum should be used. Piperacillin/tazobactam, moxifloxacin, tigecycline or ertapenem can be used for calculated treatment.

• #32

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7186812/

  Post-operative peritonitis is a nosocomially acquired secondary form of peritonitis and is defined as an infectious abdominal complication following surgery. In post-operative peritonitis, a surgical or interventional treatment is a condition in need of treatment. Most patients will already have had antimicrobial treatment at the time of illness. […] In tertiary peritonitis, infection of the abdominal cavity persists without a focus that can be remedied surgically, after previously completed infectious source rehabilitation of secondary peritonitis. For antibiotic treatment, tigecycline (possibly in combination with a Pseudomonas-active substance) as well as imipenem/cilastatin, meropenem, ceftolozane/tazobactam with metronidazole or ceftazidime/avibactam with metronidazole are available.

• #33 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Peritonitis-Treatments.aspx

  Depending on the underlying cause of bacterial contamination, surgery may be combined with lavage (cleaning out the peritoneal cavity to remove residual bacteria) and/or a course of antibiotics. […] Tertiary peritonitis is often attributed to the presence of antibiotic-resistant bacteria that are not affected by first-line antibiotics. Patients with tertiary peritonitis may be treated with stronger-acting antibiotics and may have to undergo relaparoscopy (a second laparoscopic surgery) in order to identify the root cause of infection.

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

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

  Microbiology and therapy of peritonitis in peritoneal dialysis […] This topic reviews the microbiology and therapy of peritonitis in peritoneal dialysis. […] Antimicrobial therapy […] Route of administration […] Intraperitoneal administration (preferred) […] Oral or intravenous administration […] Initial empiric therapy […] Duration of therapy […] Monitoring clinical response […] Indications for catheter removal […] Peritonitis is one of the major complications of peritoneal dialysis and remains the primary reason that patients switch from peritoneal dialysis to hemodialysis. […] The vast majority of peritonitis cases are caused by bacteria. […] Approximately 45 to 65 percent of cases are caused by gram-positive organisms and 15 to 35 percent by gram-negative organisms.

• #35

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7186812/

  CAPD peritonitis is usually caused by contamination of the tubing or catheter system. Uncomplicated cases can be treated locally by adding antimicrobial substances to the dialysis fluid. In addition to intraperitoneal treatment, parenteral treatment also becomes necessary in the rarer severe forms. Cefotaxime, cefuroxime or ceftriaxone (in monotherapy or in combination with ciprofloxacin) is recommended for calculated treatment. […] Secondary peritonitis, with perforation of the gastrointestinal tract, is by far the most common IAI, at around 80-90%. By definition, surgical source control must be carried out (infectious source rehabilitation, for example appendectomy for perforated appendicitis) or interventional treatment. In terms of a three-pillar model, diffuse peritonitis requires surgical, antimicrobial and intensive care treatment.

• #36 The new ISPD peritonitis guideline | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-018-0150-2

  The latest guideline highlights the unique features of peritonitis caused by Enterococcus species. In essence, enterococcal peritonitis should be treated with IP vancomycin for 3 weeks, and IP aminoglycoside should be added for severe cases. […] The latest guideline gives very clear cut indications of catheter removal: refractory peritonitis, relapsing peritonitis, refractory exit site and tunnel infection, and fungal peritonitis. Catheter removal may also be considered for repeat peritonitis, mycobacterial peritonitis, and peritonitis caused by multiple enteric organisms. […] As to the treatment of PD peritonitis, the new guideline emphasizes the standardization of reporting by the absolute peritonitis rate. Under the current recommendations, most peritonitis should be treated for 3 weeks, except those caused by coagulase-negative staphylococcal species or Streptococcus. […] The latest guideline includes extensive tables that describe the recommended dosage for individual antibiotics and should be frequently referred to during patient treatment.

• #37 The new ISPD peritonitis guideline | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-018-0150-2

  The latest guideline highlights the unique features of peritonitis caused by Enterococcus species. In essence, enterococcal peritonitis should be treated with IP vancomycin for 3 weeks, and IP aminoglycoside should be added for severe cases. […] The latest guideline gives very clear cut indications of catheter removal: refractory peritonitis, relapsing peritonitis, refractory exit site and tunnel infection, and fungal peritonitis. Catheter removal may also be considered for repeat peritonitis, mycobacterial peritonitis, and peritonitis caused by multiple enteric organisms. […] As to the treatment of PD peritonitis, the new guideline emphasizes the standardization of reporting by the absolute peritonitis rate. Under the current recommendations, most peritonitis should be treated for 3 weeks, except those caused by coagulase-negative staphylococcal species or Streptococcus. […] The latest guideline includes extensive tables that describe the recommended dosage for individual antibiotics and should be frequently referred to during patient treatment.

• #38 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  Other treatments. Depending on your symptoms, your treatment while in the hospital will likely include: Pain medications. Fluids given through a tube, called intravenous fluids. Oxygen. In some cases, a blood transfusion. […] If you have peritonitis, your health care provider may suggest that you receive dialysis in another way. You may need this other type of dialysis for several days while your body heals from the infection. If your peritonitis lingers or comes back, you may need to stop having peritoneal dialysis completely and switch to a different type of dialysis.

• #39 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Therefore, third-generation cephalosporins, such as cefotaxime (2 grams every 8 hours for 5 days) and ceftriaxone (1 gram every 12 hours or 2 grams every 24 hours for 5 days), are the first-line agents for empirical treatment of community-acquired SBP. […] In a randomized, controlled study involving persons with cirrhosis and SBP, the use of intravenous albumin (1.5 g/kg given within 6 hours of enrollment and repeated as a 1.0 g/kg dose on day 3) as an adjunctive to cefotaxime was shown to decrease in-hospital mortality when compared with use of cefotaxime alone (29% versus 10%). […] Due to increasing failures of initial antibiotic therapy, follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. […] If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered.

• #40 Peritonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17831-peritonitis

  Treatment typically begins with IV fluids and broad-spectrum antibiotics to treat or prevent infection. […] If later tests reveal the exact bacterium or pathogen causing your infection, you may be given a more specific antibiotic for it then. […] Your healthcare team will work to stabilize your condition before moving on to address the underlying cause. Some causes will require emergency surgery to repair.

• #41 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The management approach to peritonitis and peritoneal abscesses targets correction of the underlying process, administration of systemic antibiotics, and supportive therapy to prevent or limit secondary complications due to organ system failure. Treatment success is defined as adequate source control with resolution of sepsis and clearance of all residual intra-abdominal infection. […] Early control of the septic source is mandatory and can be achieved by operative and nonoperative means. […] Nonoperative interventions include percutaneous abscess drainage, as well as percutaneous and endoscopic stent placements. If an abscess is accessible for percutaneous drainage and if the underlying visceral organ pathology does not clearly require operative intervention, percutaneous drainage is a safe and effective initial treatment approach.

• #42 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  The treatment of peritonitis is multidisciplinary, with complementary application of medical, operative, and nonoperative interventions. Medical support includes the following: systemic antibiotic therapy, intensive care with hemodynamic, pulmonary, and renal support, nutrition and metabolic support, inflammatory response modulation therapy. […] Treatment of peritonitis and intra-abdominal sepsis always begins with volume resuscitation, correction of potential electrolyte and coagulation abnormalities, and empiric broad-spectrum parenteral antibiotic coverage. […] Antibiotic therapy is used to prevent local and hematogenous spread of infection and to reduce late complications. […] Several different antibiotic regimens are available for the treatment of intra-abdominal infections. […] The optimal duration of antibiotic therapy must be individualized and depends on the underlying pathology, severity of infection, speed and effectiveness of source control, and patient response to therapy.

• #43 Peritonitis and Abdominal Sepsis Treatment & Management: Approach Considerations, Antibiotic Therapy, Nonoperative Drainage

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

  Class I recommendations regarding empiric antibiotic selection for peritonitis by the International Society for Peritoneal Dialysis (ISPD) include initiating antibiotic therapy as soon as possible, either intraperitoneally or systemically, after obtaining appropriate microbiologic specimens. […] Drainage refers to evacuation of an abscess. This can be performed operatively or percutaneously under ultrasound or CT guidance. […] In some instances, success of nonoperative drainage also includes the ability to delay surgery until the acute process and sepsis are resolved and a definitive procedure can be performed under elective circumstances. […] Nutritional demands increase during sepsis, with caloric requirements of 25-35 kcal/kg/d. Patients with sepsis should be fed a high-protein isocaloric diet. […] The treatment of intra-abdominal sepsis requires a multidisciplinary approach. In the treatment of secondary peritonitis, a surgeon must be consulted.

• #44 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Therefore, third-generation cephalosporins, such as cefotaxime (2 grams every 8 hours for 5 days) and ceftriaxone (1 gram every 12 hours or 2 grams every 24 hours for 5 days), are the first-line agents for empirical treatment of community-acquired SBP. […] In a randomized, controlled study involving persons with cirrhosis and SBP, the use of intravenous albumin (1.5 g/kg given within 6 hours of enrollment and repeated as a 1.0 g/kg dose on day 3) as an adjunctive to cefotaxime was shown to decrease in-hospital mortality when compared with use of cefotaxime alone (29% versus 10%). […] Due to increasing failures of initial antibiotic therapy, follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. […] If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered.

• #45 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  The terms peritonitis, intra-abdominal infection, and abdominal sepsis are not synonymous, yet sometimes they are used indistinctly to define similar clinical states. Peritonitis is defined as an inflammatory process of the peritoneum caused by any irritant/agent such as bacteria, fungi, virus, talc, drugs, granulomas, and foreign bodies. Intra-abdominal infection is defined as the local manifestations that occur as a consequence of peritonitis. Intra-abdominal sepsis entails a systemic manifestation of a severe peritoneal inflammation. […] […] The mortality of an intra-peritoneal infection in the early 1900s was close to 90%. This condition was managed nonoperatively until Kishner introduced the basic principles of surgery in intra-abdominal infections: (1) elimination of the septic foci, (2) removal of necrotic tissue, and (3) drainage of purulent material. By the 1930s, mortality had been reduced to 50%. With the introduction of antibiotics, the mortality continued to decrease slowly. The use of cephalosporins by the early 1970s was associated with a reduction of mortality to less than 30% to 40%. Subsequent advances in the understanding of physiology, the monitoring and support of the cardiopulmonary systems, the rational use of new drugs, and ICU care aided in stabilizing mortality at around 30%. […]

• #46 Management of Peritonitis in the Critically Ill Patient

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3413265/

  There is no controversy regarding the standard treatment that includes control of the source and intra-abdominal lavage (washing); however, in patients who have advanced peritonitis, the source of the infection may not be completely eradicated with a single operation. Thus controversy arises, specifically regarding issues such as time and frequency of repetitive laparotomies, and management of the open wound/abdomen. Furthermore, the aggressive resuscitation required in these patients causes gut and abdominal wall edema that may be associated with increased intra-abdominal pressure, worsened by a premature closing of the abdominal wall. To date, it is clear that the reduction of mortality below 20% has been the result of a better understanding of the role of damage control, prevention of intra-abdominal compartment syndrome, and improved antibiotic alternatives with broad-spectrum newer medications. […]

Zobacz więcej