Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
Institute for Medical Microbiology, Virology and Hygiene, Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
Int J Surg. 2019 Oct;70:63-69. doi: 10.1016/j.ijsu.2019.08.020. Epub 2019 Aug 19.
Acute postoperative peritonitis resulting from previous abdominal surgery is still a severe and potentially fatal disease, which is associated with high morbidity and mortality. The aim of the present study was to evaluate patients' outcome after postoperative peritonitis and identify the most effective empiric antibiotic regimes.
422 patients with acute postoperative peritonitis as a result to earlier abdominal operation (e.g. anastomotic leakage) were analyzed retrospectively focusing on the origin of the peritonitis, microbial flora and resistance patterns. Furthermore, mortality was estimated according to sensitivity results of the tested antibiotics.
In 50% of the patients, anastomotic leakage was located in the colon. The predominantly cultured microorganisms were Escherichia coli and Enterobacteriaceae. The combination of meropenem and vancomycin was effective in 96% of these microbes. The frequently used combinations of piperacillin/sulbactam and cefotaxime/metronidazole were effective in only 67% and 43%, respectively.
We were able to show that the currently used antibiotic regimes with piperacillin/sulbactam and cefotaxime/metronidazole are ineffective in a relevant number of patients with anastomotic leakage. Only meropenem or meropenem/vancomycin cover most of the microbes predominant in postoperative peritonitis.
既往腹部手术导致的急性术后腹膜炎仍然是一种严重且潜在致命的疾病，其发病率和死亡率均较高。本研究旨在评估术后腹膜炎患者的预后，并确定最有效的经验性抗生素治疗方案。
回顾性分析了 422 例因早期腹部手术（如吻合口漏）导致的急性术后腹膜炎患者，重点关注腹膜炎的来源、微生物菌群和耐药模式。此外，根据测试抗生素的敏感性结果来估计死亡率。
在 50%的患者中，吻合口漏位于结肠。主要培养的微生物为大肠杆菌和肠杆菌科。美罗培南和万古霉素的联合用药对这些微生物的有效率为 96%。哌拉西林/舒巴坦和头孢噻肟/甲硝唑的常用联合用药的有效率分别为 67%和 43%。
我们能够表明，目前使用哌拉西林/舒巴坦和头孢噻肟/甲硝唑的抗生素治疗方案在相当数量的吻合口漏患者中无效。只有美罗培南或美罗培南/万古霉素能覆盖术后腹膜炎中主要存在的大多数微生物。
