Marques Hanna Santos, Araújo Glauber Rocha Lima, da Silva Filipe Antônio França, de Brito Breno Bittencourt, Versiani Paulo Victor Dias, Caires Jaqueline Silva, Milet Thiago de Carvalho, de Melo Fabrício Freire
Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil.
Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil.
World J Clin Cases. 2021 Apr 6;9(10):2160-2169. doi: 10.12998/wjcc.v9.i10.2160.
Intra-abdominal infections can be classified into uncomplicated or complicated (peritonitis). Peritonitis is divided into primary, secondary, and tertiary. Tertiary peritonitis is the less common but the most severe among peritonitis stratifications, being defined as a recurrent intra-abdominal infection that occurs 48 h after a well-succeeded control of a secondary peritonitis. This disease has a complex pathogenesis that is closely related to the capacity of the peritoneal cavity to activate immunological processes. Patients who progress to persistent peritonitis are at an increased risk of developing several infectious complications such as sepsis and multiple organ failure syndrome. Moreover, tertiary peritonitis remains an important cause of hospital death mainly among patients with associated risk factors. The microbiological profile of organisms causing tertiary peritonitis is often different from that observed in other types of peritonitis. In addition, there is a high prevalence of multidrug-resistant pathogens causing this condition, and an appropriate and successful clinical management depends on an early diagnosis, which can be made easier with the use of clinical scores presenting a good prediction value during the intensive care unit admission. Complementarily, immediate therapy should be performed to control the infectious focus and to prevent new recurrences. In this sense, the treatment is based on initial antimicrobial therapy and well-performed peritoneal drainage.
腹腔内感染可分为单纯性或复杂性（腹膜炎）。腹膜炎分为原发性、继发性和 tertiary。Tertiary 腹膜炎在腹膜炎分层中较少见但最严重，定义为在继发性腹膜炎成功控制 48 小时后发生的复发性腹腔内感染。这种疾病的发病机制复杂，与腹腔激活免疫过程的能力密切相关。进展为持续性腹膜炎的患者发生败血症和多器官功能衰竭综合征等多种感染并发症的风险增加。此外，tertiary 腹膜炎仍然是主要在伴有危险因素的患者中导致医院死亡的重要原因。引起 tertiary 腹膜炎的微生物谱通常与其他类型腹膜炎中观察到的不同。此外，导致这种情况的多重耐药病原体患病率很高，适当且成功的临床管理取决于早期诊断，在重症监护病房入院期间使用具有良好预测价值的临床评分可以更容易地进行早期诊断。作为补充，应立即进行治疗以控制感染灶并防止新的复发。从这个意义上说，治疗基于初始抗菌治疗和良好的腹腔引流。
