ORIGINAL ARTICLE   

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

DOI: 10.23736/S0375-9393.21.15859-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

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