JAC Advance Access published online on September 6, 2002
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkf167
© 2002 by The British Society for Antimicrobial Chemotherapy
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Original Paper
1 Internal
Medicine B, University-Hospital
of Nîmes, Nîmes, France
* Corresponding author. E-mail: albert.sotto{at}chu-nimes.fr.
Received 12 November 2001
; 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.
Evaluation of antimicrobial therapy management
of 120 consecutive patients with secondary peritonitis
2 Critical Care
and Emergency, University-Hospital
of Nîmes, Nîmes, France
3 Medical Biostatistics, University-Hospital
of Nîmes, Nîmes, France
4 Surgery A, University-Hospital
of Nîmes, Nîmes, France
5 Surgery B, University-Hospital
of Nîmes, Nîmes, France
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