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Langenbeck's Archives of Surgery

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01-03-2009 | Original Article

Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis

Authors: Peter Panhofer, Barbara Izay, Markus Riedl, Veronika Ferenc, Martin Ploder, Raimund Jakesz, Peter Götzinger

Published in: Langenbeck's Archives of Surgery | Issue 2/2009

Abstract

Background and aims

Tertiary peritonitis is a severe persisting intra-abdominal infection and associated with high mortality. The aim was to find significant risk factors for mortality and tertiary peritonitis including the Mannheim Peritonitis Index (MPI), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a sumscore of both.

Materials and methods

In this retrospective single-center cohort study, 122 patients were treated at the Surgical Department of a University Hospital.

Results

Sixty-nine patients (56.6%) developed tertiary peritonitis. Nineteen patients (27.5%), who suffered from tertiary peritonitis, died in contrast to eight patients (15.1%) with secondary peritonitis (P = 0.101). Patients with tertiary peritonitis had significantly higher APACHE II (P < 0.001), MPI (P = 0.035), and combined APACHE II and MPI scores (P < 0.001) than patients with secondary peritonitis. Age (P = 0.035), fungal infections (P = 0.025), and infections with more than one microbial organism (P = 0.047) were predictive for tertiary peritonitis. Combined APACHE II and MPI scores detected tertiary peritonitis better than the MPI (P = 0.014). Detection of mortality was comparable in all evaluated prognostic scores.

Conclusion

Prognostic scores besides age and fungal infections are risk factors for mortality and help to differentiate between secondary and tertiary peritonitis. The combination of prognostic scores is comparable to the APACHE II and superior compared to the MPI in regard to detection of tertiary peritonitis.

Barie PS, Hydo LJ, Eachempati SR (2004) Longitudinal outcomes of intra-abdominal infection complicated by critical illness. Surg Infect 5:365–373CrossRef

Buijk SE, Bruining HA (2002) Future directions in the management of tertiary peritonitis. Intensive Care Med 28:1024–1029PubMedCrossRef

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRef

Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM, Welling RE, Moore EE (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216:172–183PubMedCrossRef

Orozco H, Arch J, Medina-Franco H, Pantoja JP, Gonzalez QH, Vilatoba M, Hinojosa C, Vargas-Vorackova F, Sifuentes-Osornio J (2006) Molgramostim (GM-CSF) associated with antibiotic treatment in nontraumatic abdominal sepsis: a randomized, double-blind, placebo-controlled clinical trial. Arch Surg 141:150–153PubMedCrossRef

Barie PS (1999) Management of complicated intra-abdominal infections. J Chemoth 11:464–477

Nathens AB, Rotstein OD, Marshall JC (1998) Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg 22:158–163PubMedCrossRef

Billing A, Frohlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Br J Surg 81:209–213PubMedCrossRef

Bosscha K, Rejinders K, Hulstaert F, Algra A, Van der Werken C (1997) Prognostic scoring systems to predict outcome in peritonitis and intraabdominal sepsis. Br J Surg 84:1532–1534PubMedCrossRef

10.

Fugger R, Rogy M, Herbst F, Schemper M, Schulz F (1988) Validation study of the Mannheim Peritonitis Index. Chirurg 59:598–601PubMed

11.

Rogy M, Fugger R, Schemper M, Koss G, Schulz F (1990) The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score. Chirurg 61:297–300PubMed

12.

Biondo S, Ramos E, Fraccalvieri D, Kreisler E, Martí Ragué J, Jaurrieta E (2006) Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index. Br J Surg 93:616–622PubMedCrossRef

13.

Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Grundlach E (1987) The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg 58:84–92PubMed

14.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef

15.

Bohnen J, Mustard RA, Oxholm SE, Schouten D (1988) APACHE II score and abdominal infection. Arch Surg 123:225–229PubMed

16.

Ohmann C, Wittmann DH, Wacha H (1993) Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group. Eur J Surg 159:267–274PubMed

17.

Götzinger P, Wamser P, Barlan M, Sautner T, Jakesz R, Függer R (2000) The surgical concepts of planned and on-demand reoperation in the treatment of diffuse intra-abdominal infection. Eur Surg 32:1–4CrossRef

18.

Lamme B, Boermeester MA, Belt EJ, van Till JW, Gouma DJ, Obertop H (2004) Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis. Br J Surg 91:1046–1054PubMedCrossRef

19.

Weiss G, Meyer F, Lippert H (2006) Infectiological diagnostic problems in tertiary peritonitis. Langenbecks Arch Surg 391:473–482PubMedCrossRef

20.

Evans HL, Raymond DP, Pelletier SJ, Crabtree TD, Pruett TL, Sawyer RG (2001) Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection. Surg Infect 2:255–263CrossRef

21.

Klingler A (2004) Statistical methods in surgical research—a practical guide. Eur Surg 36:80–84CrossRef

22.

Panhofer P, Riedl M, Izay B, Ferenc V, Ploder M, Jakesz R, Götzinger P (2007) Clinical outcome and microbial flora in patients with secondary and tertiary peritonitis. Eur Surg 39:259–264CrossRef

23.

Malangoni MA (2000) Evaluation and management of tertiary peritonitis. Am Surg 66:157–161PubMed

24.

Evans HL, Raymond DP, Pelletier SJ, Crabtree TD, Pruett TL, Sawyer RG (2001) Diagnosis of intra-abdominal infection in the critically ill patient. Curr Opin Crit Care 7:117–121PubMedCrossRef

25.

Marshall JC, Innes M (2003) Intensive care unit management of intra-abdominal infection. Crit Care Med 31:2228–2237PubMedCrossRef

26.

Butler JA, Huang J, Wilson SE (1987) Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors. Arch Surg 122:702–706PubMed

27.

Marshall JC, Christou NV, Horn R, Meakins JL (1988) The microbiology of multiple organ failure. Arch Surg 123:309–315PubMed

28.

Barie PS, Hydo LJ, Fischer E (1996) Development of multiple organ dysfunction syndrome in critically ill patients with perforated viscus. Arch Surg 123:225–229

29.

Christou NV, Barie PS, Dellinger EP, Waymack JP, Stone HH (1993) Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. Arch Surg 128:193–198PubMed

30.

Koperna T, Schulz F (1996) Prognosis and treatment of peritonitis. Do we need new scoring systems? Arch Surg 131:180–186PubMed

31.

Cerra FB, Negro F, Abrams J (1990) APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients. Arch Surg 125:519–522PubMed

32.

Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrare JSF (1995) Multiple-organ failure: generalized autodestructive inflammation? Arch Surg 44:937–946

33.

Sautner T, Götzinger P, Redl-Wenzl EM, Dittrich K, Felfernig M, Sporn P, Roth E, Függer R (1997) Does reoperation for abdominal sepsis enhance the inflammatory host response? Arch Surg 132:250–255PubMed

Title: Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis
Authors: Peter Panhofer
Barbara Izay
Markus Riedl
Veronika Ferenc
Martin Ploder
Raimund Jakesz
Peter Götzinger
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 2/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0301-y

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Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis

Abstract

Background and aims

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background and aims

Materials and methods

Results

Conclusion

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