Therapeutic management of peritonitis: a comprehensive guide for intensivists

Montravers, P., Blot, S., Dimopoulos, G., Eckmann, C., Eggimann, P., Guirao, X., Paiva, J. A., Sganga, G. and de Waele, J. (2016) Therapeutic management of peritonitis: a comprehensive guide for intensivists. Intensive Care Medicine, 42 8: 1234-1247. doi:10.1007/s00134-016-4307-6


Author Montravers, P.
Blot, S.
Dimopoulos, G.
Eckmann, C.
Eggimann, P.
Guirao, X.
Paiva, J. A.
Sganga, G.
de Waele, J.
Title Therapeutic management of peritonitis: a comprehensive guide for intensivists
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 1432-1238
0342-4642
Publication date 2016-08
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s00134-016-4307-6
Open Access Status Not Open Access
Volume 42
Issue 8
Start page 1234
End page 1247
Total pages 14
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2017
Language eng
Formatted abstract
Purpose: The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) bacteria.

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

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

Conclusions: The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.
Keyword Fungal infection
Intra-abdominal hypertension
Multidrug-resistant bacteria
Peritonitis
Postoperative complications
Source control
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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