JAC Advance Access originally published online on September 6, 2002
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Journal of Antimicrobial Chemotherapy (2002) 50, 569-576
© 2002 The British Society for Antimicrobial Chemotherapy
Evaluation of antimicrobial therapy management of 120 consecutive patients with secondary peritonitis
Departments of 1 Internal Medicine B, 2 Critical Care and Emergency, 3 Medical Biostatistics, 4 Surgery A and 5 Surgery B, University-Hospital of Nîmes, Nîmes, France
Received 12 November 2001; returned 2 March 2002; revised 13 June 2002; accepted 8 July 2002
Objectives: To evaluate antimicrobial therapy management of secondary peritonitis in a University Hospital.
Patients and methods: All patients admitted to the intensive care unit of the University Hospital of Nîmes from 1 January 1997 to 31 July 1999 with a diagnosis of secondary peritonitis were retrospectively included. Patients’ medical records were collected from the data recordings of the Department of Critical Care and Emergency and the Departments of Surgery. Acute Physiology and Chronic Health Evaluation II (APACHE II) was calculated for each patient at the time of admission. Antimicrobial treatment management before and after the diagnosis of peritonitis was studied.
Results: One hundred and twenty patients were included. Results concerning mortality, aetiology of peritonitis and microbiological data were in accordance with previous studies. APACHE II score (P = 0.005), age (P = 0.002), presence of Enterococcus in the peri-operative samples (P = 0.02) and period between diagnosis and surgery (P = 0.04) were predictive of death within 30 days after diagnosis of peritonitis. No significant difference was shown in the mortality rate in patients whose post-operative antibiotic treatment was changed following results of intra-operative peritoneal cultures versus patients having inappropriate treatment (P = 0.96). The same observations were noted for anti-enterococcal treatment.
Conclusion: This study emphasizes the importance of prompt surgical treatment and shows the modest impact of adapting antibiotic treatment. The morbidity and mortality associated with the presence of Enterococcus, which was not influenced by antibiotic treatment, would seem to suggest the pro-inflammatory role of Enterococcus. However, prospective randomized studies are needed to evaluate the real contribution of enterococcal antibiotic coverage in this context.
* Correspondence address. Département de Médecine Interne, Hopital Carémeau, rue du Professeur Debré, 30029 Nîmes Cedex 04, France. Tel: +33-4-66-68-32-31; Fax: +33-4-66-68-38-24; E-mail: albert.sotto{at}chu-nimes.fr
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