Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2022 May;88(5) > Minerva Anestesiologica 2022 May;88(5):361-70

ULTIMO FASCICOLO
 

JOURNAL TOOLS

Opzioni di pubblicazione
eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo
Share

 

ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 May;88(5):361-70

DOI: 10.23736/S0375-9393.21.15859-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Severe secondary peritonitis: impact of inappropriate initial antimicrobial therapy on prognosis and potential carbapenem-sparing

Hugues GEORGES 1 , Adrien KRINGS 1, Patrick DEVOS 2, Pierre-Yves DELANNOY 1, Nicolas BOUSSEKEY 1, Damien THELLIER 1, Vanessa JEAN-MICHEL 1, Thomas CAULIER 1, Olivier LEROY 1

1 Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France; 2 CHU Lille, University of Lille, Lille, France



BACKGROUND: Initiation of antimicrobial therapy (IAT) with broad-spectrum antibiotics is usual in Intensive Care Unit (ICU) patients with secondary peritonitis. Carbapenems are widely proposed by recent guidelines contrasting with current antibiotic stewardship policies of carbapenem-sparing. However, prognosis of inappropriate IAT remains unclear in these patients and broad-spectrum antibiotics are probably overused. We aimed to assess the role of inappropriate IAT in ICU patients with secondary peritonitis and the use of carbapenems in our IAT regimens.
METHODS: We performed a retrospective analysis during a six-year period including 131 ICU patients with secondary peritonitis. We collected data concerning comorbidities, source and severity of peritonitis, management of IAT, peritoneal samples and outcome.
RESULTS: Forty-one patients presented with community acquired peritonitis (CAP) and 90 with postoperative peritonitis (POP). Thirty-seven (28.2%) patients died during ICU stay. IAT was inappropriate in 35 (26.7%) patients. Inappropriate IAT was not associated with reduced survival with respectively 26 (27%) deaths when IAT was adequate and 11 (31.4%) deaths when IAT was inadequate (P=0.87). Inappropriate IAT was not associated with the need of re-operation and duration of ICU stay. Carbapenems were delivered in 29 patients but were only necessary for eight patients without alternative treatment.
CONCLUSIONS: In our study, inappropriate IAT was not associated with a worse prognosis and carbapenems were overused. Extensive delivery of carbapenems proposed by recent guidelines could be reconsidered in the management of these patients.


KEY WORDS: Peritonitis; Prognosis; Intensive care units

inizio pagina