Montravers P, Gauzit R, Muller C, Marmuse J P, Fichelle A, Desmonts J M
Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Bichat, Paris, France.
Clin Infect Dis. 1996 Sep;23(3):486-94. doi: 10.1093/clinids/23.3.486.
In cases of community-acquired peritonitis, the adequacy of emprical antibiotic treatment has been shown to attenuate mortality and morbidity. The impact of empirical antibiotics on the outcome of postoperative peritonitis has never been evaluated. This study included 100 consecutively studied patients with postoperative peritonitis. The adequacy of emprical treatment was determined by means of culture and susceptibility data obtained at the time of reoperation, and the effect of such treatment on outcome was evaluated. One hundred resistant pathogens were isolated from 70 patients, of whom 45% died; by comparison, mortality among those from whom susceptible organisms were isolated was 16% (P < .05). Inadequate empirical treatment was administered to 54 patients and was associated with poorer outcome (P < or = .05). The outcome of postoperative peritonitis is affected by the choice and adequacy of the initial empirical antibiotic therapy. Late changes in antibiotic therapy based on culture results did not affect outcome when the initial regimen was inadequate.
在社区获得性腹膜炎病例中，经验性抗生素治疗的充分性已被证明可降低死亡率和发病率。经验性抗生素对术后腹膜炎结局的影响从未得到评估。本研究纳入了100例连续研究的术后腹膜炎患者。通过再次手术时获得的培养和药敏数据确定经验性治疗的充分性，并评估这种治疗对结局的影响。从70例患者中分离出100种耐药病原体，其中45%死亡；相比之下，分离出敏感菌的患者死亡率为16%（P<0.05）。54例患者接受了不充分的经验性治疗，且与较差的结局相关（P≤0.05）。术后腹膜炎的结局受初始经验性抗生素治疗的选择和充分性影响。当初始治疗方案不充分时，基于培养结果的抗生素治疗后期调整并不影响结局。
