Content uploaded by Anika Fichelle
Author content
All content in this area was uploaded by Anika Fichelle
Content may be subject to copyright.
A preview of the PDF is not available
Emergence of Antibiotic-Resistant Bacteria in Cases of Peritonitis After Intraabdominal Surgery Affects the Efficacy of Empirical Antimicrobial Therapy
Abstract and Figures
In cases of community-acquired peritonitis, the adequacy of empirical 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 empirical 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 associatedwith poorer outcome(P ⩽ .05). The outcomeof 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.
Figures - uploaded by Anika Fichelle
Author content
All figure content in this area was uploaded by Anika Fichelle
Content may be subject to copyright.
... Anesthesia for postoperative peritonitis (PPO) is particularly difficult because these patients are most often fragile, undernourished, with sepsis, candidates for multi-organ failure and presenting a very high risk of mortality [2]. Like any nosocomial infection, their prognosis is often severe, marked by high morbidity, mortality ranging from 12% to 80% depending on the series, an extension of the length of stay in intensive care and hospital and potentially serious sequelae [3,4,5]. ...
... However, in the Mwembia A. (2012) series, PPO mortality reached 74% [16]. Despite progress in treatment, the prognosis of PPO still remains gloomy with a mortality rate ranging from 12% to 80% [3,4,5]. Several studies [6,9] have been carried out in order to identify these different prognostic factors influencing the mortality rate of peritonitis. ...
... The management of PPO is based on 3 objectives: control of septic shock, appropriate and early antibiotic therapy and early surgery. Several studies have shown that if they are not reached, the mortality rate increases considerably [3,51,52]. Thus in the literature, the factors of poor prognosis in the PPO are diverse and can be related to the patient, to the initial surgery and the reoperation, to the per and postoperative complications in particular the organ failure and the quality of the care as inappropriate antibiotic therapy [22,53,54]. In multivariate analysis, four factors emerged as predictors of mortality during PPO: age > 65 years, altered consciousness at the entrance to the operating room, ASA class > III and the presence of intraoperative complications. ...
... Treatment is primarily surgical and must be as effective as possible from the outset. Anastomotic dehiscence or leakage is the main etiology [2,3]. ...
... It is difficult to assess the incidence of different etiologies of PPO due to the variability in recruitment of patients and hospitals as well as changes in patient management over time. The most common cause of PPO is fistula or anastomotic leak [2,3]. The prevalence of anastomotic leaks has been reported to range from 0.5% to 21% after colonic or rectal resection [4]. ...
Introduction: Postoperative peritonitis is a serious complication occurring after abdominal surgery, usually digestive. Like all diseases associated with care, its prognosis is often severe, marked by high morbidity, prolonged stays in intensive care and in hospital, and potentially serious sequelae. Material and Methods: This is a retrospective study of patients operated on in the visceral surgical emergency department with a passage to the visceral surgical emergency department for postoperative peritonitis from January 2021 to November 2022. Results: From January 2021 to November 2022 we operated 1493 patients including 14 postoperative peritonitis, i.e. 0.9%. Among the 14 patients: 4 were women (28.6%) and 10 were men (71.4%) with a sex ratio of 2.5. Occlusions were the dominant pathology. The multivariate analysis showed a significant relationship between age, delay before consultation and the occurrence of complications. Conclusion: PPO still have a high mortality but which continues to decrease thanks to an effective medical and surgical management.
... thetaiotaomicron or B. fragilis) which is commonly seen in immunocompromised individuals. [59][60][61][62] Therein, further in vivo validation is required to investigate the potential pathobiont role of Bacteroidota species in IBD. ...
Comensal Bacteroidota (Bacteroidota) and Enterobacteriacea are often linked to gut inflammation. However, the causes for variability of pro-inflammatory surface antigens that affect gut commensal/opportunistic dualism in Bacteroidota remain unclear. By using the classical lipopolysaccharide/O-antigen ‘rfb operon’ in Enterobacteriaceae as a surface antigen model (5-rfb-gene-cluster rfbABCDX), and a recent rfbA-typing strategy for strain classification, we characterized the integrity and conservancy of the entire rfb operon in Bacteroidota. Through exploratory analysis of complete genomes and metagenomes, we discovered that most Bacteroidota have the rfb operon fragmented into nonrandom patterns of gene-singlets and doublets/triplets, termed ‘rfb-gene-clusters’, or rfb-‘minioperons’ if predicted as transcriptional. To reflect global operon integrity, contiguity, duplication, and fragmentation principles, we propose a six-category (infra/supra-numerary) cataloging system and a Global Operon Profiling System for bacteria. Mechanistically, genomic sequence analyses revealed that operon fragmentation is driven by intra-operon insertions of predominantly Bacteroides-DNA (thetaiotaomicron/fragilis) and likely natural selection in gut-wall specific micro-niches or micropathologies. Bacteroides-insertions, also detected in other antigenic operons (fimbriae), but not in operons deemed essential (ribosomal), could explain why Bacteroidota have fewer KEGG-pathways despite large genomes. DNA insertions, overrepresenting DNA-exchange-avid (Bacteroides) species, impact our interpretation of functional metagenomics data by inflating by inflating gene-based pathway inference and by overestimating ‘extra-species’ abundance. Of disease relevance, Bacteroidota species isolated from cavitating/cavernous fistulous tract (CavFT) microlesions in Crohn’s Disease have supra-numerary fragmented operons, stimulate TNF-alpha from macrophages with low potency, and do not induce hyperacute peritonitis in mice compared to CavFT Enterobacteriaceae. The impact of ‘foreign-DNA’ insertions on pro-inflammatory operons, metagenomics, and commensalism/opportunism requires further studies to elucidate their potential for novel diagnostics and therapeutics, and to elucidate the role of co-existing pathobionts in Crohn’s disease microlesions.
... Peritonitis as a complication of a limited (organ) focus of infection or abdominal intervention refers to severe infections with a high mortality rate [1]. ...
To study the structure and antibiotic resistance of pathogens of intraabdominal infections and to evaluate in vitro antibacterial efficacy of polyvalent pyobacteriophage "Sextaphag" on the biomaterial obtained from patients with peritonitis of different etiology
... In the last three decades, antimicrobial resistance in NP has emerged as a serious global threat alongside other nosocomial infections in critically ill patients. In hospitals and countries where MDR pathogens are endemic, NP frequently involves MDR microorganisms [24][25][26][27][28], carbapenem resistance, and extended-spectrum β-lactamase (ESBL) production in Gram-negative bacteria, especially in Klebsiella pneumoniae, Acinetobacter bau-mannii, and Pseudomonas aeruginosa; to a lesser extent, vancomycin resistance in Enterococcus faecium and methicillin-resistance in Staphylococcus aureus have been repeatedly reported for bacterial strains isolated in NP cases from critically ill patients [29,30]. ...
This comprehensive review aims to provide a practical guide for intensivists, focusing on enhancing patient care associated with nosocomial peritonitis (NP). It explores the epidemiology, diagnosis, and management of NP, a significant contributor to the mortality of surgical patients worldwide. NP is, per definition, a hospital-acquired condition and a consequence of gastrointestinal surgery or a complication of other diseases. NP, one of the most prevalent causes of sepsis in surgical Intensive Care Units (ICUs), is often associated with multi-drug resistant (MDR) bacteria and high mortality rates. Early clinical suspicion and the utilization of various diagnostic tools like biomarkers and imaging are of great importance. Microbiology is often complex, with antimicrobial resistance escalating in many parts of the world. Fungal peritonitis and its risk factors, diagnostic hurdles, and effective management approaches are particularly relevant in patients with NP. Contemporary antimicrobial strategies for treating NP are discussed, including drug resistance challenges and empirical antibiotic regimens. The importance of source control in intra-abdominal infection management, including surgical and non-surgical interventions, is also emphasized. A deeper exploration into the role of open abdomen treatment as a potential option for selected patients is proposed, indicating an area for further investigation. This review underscores the need for more research to advance the best treatment strategies for NP.
Aim
During liver transplantation, both hospital-acquired (HA) and community-acquired (CA) intra-abdominal infections (IAIs) are involved causing life-threatening diseases. Therefore, comparative studies of aerobic and facultative anaerobic HA-IAIs and CA-IAIs after liver transplantation surgery are necessary.
Methods and Results
the species of detected isolates (310) from intra-abdominal fluid were identified and classified into HA-IAIs and CA-IAIs. Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii were the most commonly detected species. The resistant phenotypes were commonly detected among the HA-IAIs; however, the virulent phenotypes were the predominant strains of CA-IAIs. Regrettably, the resistance profiles were shocking, indicating the inefficacy of monotherapy in treating these isolates. Therefore, we confirmed the use of empirical combination therapies of amikacin and meropenem for treating all IAIs (FICI≤0.5). Unfortunately, the high diversity and low clonality of all identified HA and CA-IAIs were announced with D-value in the range of 0.992 and 1.
Conclusion
This diversity proves that there are infinite numbers of infection sources inside and outside healthcare centers.
This chapter outlines the essentials and most current concepts and understanding of the relevant epidemiology, definitions, pathogenesis, diagnosis and investigation, and management principles of patients with sepsis and septic shock in a pragmatic and evidence-based fashion, and as may be pertinent to patients with penetrating trauma. Sepsis and septic shock are common and should be regarded as medical emergencies. Patients with penetrating trauma are at high risk for the development of sepsis and its associated sequelae. Early recognition, focussed fluid administration and haemodynamic support, source control, and appropriate antimicrobial therapy are the cornerstones that offer the best possible survival outcomes for patients suffering from sepsis and septic shock. Appropriate supportive measures and post sepsis care are important and integral components of care that further enhance outcomes. Adherence to these principles which are based on current best practice, is key to reducing the burden of resulting disease, death, and disability from sepsis and septic shock in patients with penetrating trauma.
Protection against lethal Candida albicans ( Ca )/ Staphylococcus aureus ( Sa ) intra-abdominal infection (IAI)-mediated sepsis can be achieved by a novel form of trained innate immunity (TII) involving Gr-1+ myeloid-derived suppressor cells (MDSCs) that are induced by inoculation (immunization) with low virulence Candida species [i.e., Candida dubliniensis ( Cd )] that infiltrate the bone marrow (BM). In contrast, more virulent Candida species (i.e., C. albicans ), even at sub-lethal inocula, fail to induce similar levels of protection. The purpose of the present study was to test the hypothesis that the level of TII-mediated protection induced by Ca strains inversely correlates with damage in the BM as a reflection of virulence. Mice were immunized by intraperitoneal inoculation with several parental and mutant strains of C. albicans deficient in virulence factors (hyphal formation and candidalysin production), followed by an intraperitoneal Ca/Sa challenge 14 d later and monitored for sepsis and mortality. Whole femur bones were collected 24 h and 13 d after immunization and assessed for BM tissue/cellular damage via ferroptosis and histology. While immunization with standard but not sub-lethal inocula of most wild-type C. albicans strains resulted in considerable mortality, protection against lethal Ca / Sa IAI challenge varied by strain was usually less than that for C. dubliniensis , with no differences observed between parental and corresponding mutants. Finally, levels of protection afforded by the Ca strains were inversely correlated with BM tissue damage ( R ² = −0.773). TII-mediated protection against lethal Ca/Sa sepsis induced by Candida strain immunization inversely correlates with BM tissue/cellular damage as a reflection of localized virulence.
The pattern of life-threatening bacterial infections has changed since the introduction of potent antimicrobial agents. Infections caused by pneumococci and β-hemolytic streptococci are less frequent causes of potentially fatal infections, and severe infections caused by staphylococci, other bacteria, and fungi are relatively more frequent. 1-3 The importance and increasing incidence of infections caused by Gram-negative bacilli have been pointed out by several investigators, 1,4-7 but infections caused by these microorganisms have received less attention than those due to staphylococci. This report reviews the experience with Gram-negative bacteremia during an 8-year period at the University of Illinois Research and Educational Hospitals. The etiology and some aspects of the ecology of these infections have been determined and are reported in this paper. Clinical manifestations, the effect of corticosteroid administration, and antibiotic prophylaxis and therapy of Gram-negative bacteremia are given in another report. Clinical Material All blood culture isolates of a species of
A prospective in vitro survey of Gram-negative isolates obtained from patients hospitalized in intensive care units in 10 Boston teaching hospitals was undertaken to document current susceptibility patterns and analyze patterns of cross-resistance. One thousand and five isolates were obtained, 18% were pseudomonas, 18% Escherichia coli, 13% klebsiella, and 22% were in the enterobacter, citrobacter, serratia group. Cross-resistance among beta-lactams and beta-lactamase inhibitors was common for species with a potential to produce the type I inducible beta-lactamase (p less than 0.01). In contrast, resistance to imipenem was not associated with cross-resistance. Ciprofloxacin and netilmicin also remained active. Clinical observations of the development of cross-resistance to the beta-lactams in enterobacter and citrobacter infections in four patients (two bacteremias and two wound infections) seen in one institution confirm these in vitro findings. Unanswered questions remain regarding the frequency of beta-lactam cross-resistance, the most likely sites of occurrence and the overall clinical significance. Clinicians should be aware of the potential selection of type-I beta-lactamase hyperproducers by the use of second or third generation cephalosporins or related beta-lactam agents.
An in vitro study on the prevalence of resistance to major antibiotics in 1,545 Gram-negative aerobic bacilli isolated from intensive care unit patients was undertaken in 16 community and university hospitals in Belgium. A customized dry microtitre panel carrying 16 antimicrobials over an extended concentration range was used for susceptibility testing. The study revealed a widespread resistance to broad-spectrum penicillins, an alarmingly high incidence of resistance to aminoglycosides and a reduced activity of third generation cephalosporins especially in nosocomial pathogens, and a still relatively high susceptibility to imipenem and ciprofloxacin. Wide variations in percentage of resistance to different antibiotics were observed between hospitals, and these differences were not related to type of hospital or number of beds.
At the beginning of 1990, 10 German hospitals participated in a surveillance study of 100 consecutively submitted Gram-negative aerobes originating in their intensive care units (ICUs). A total of 1,006 isolates were obtained from 446 patients. Resistance rates cited apply to the initial strains isolated and use the NCCLS fully susceptible breakpoint. Over 1/3 of the penicillin resistant populations of E. coli and Klebsiella spp. were resistant to amoxicillin/clavulanate and simultaneously resistant to cefazolin and cefuroxime. These resistance patterns were found in 9/10 hospitals. Resistance to 3rd generation cephalosporins was rare and confined to 2/10 centers. Enterobacteriaceae with inducible beta-lactamase, e.g. Enterobacter spp., Serratia spp., C. freundii and Morganella spp., were in all centers the major source of isolates resistant to 3rd generation cephalosporins and ureidopenicillins. Cross-resistance between these agents was extensive. Both imipenem and ciprofloxacin remained active against this species group. Resistance rates to anti-pseudomonal agents ranged from 10 to 20%. Analysis of cross-resistance in P. aeruginosa revealed a correlated magnitude of resistance between cephalosporins and penicillins, but none toward imipenem. Resistance acquisition reached 50% for cephalosporins in those patients providing repeated isolates of the inducible Enterobacteriaceae. High rates of resistance development prior to and during ICU occupancy could explain why rates of resistance observed in this study were 1.6-fold higher than reported in recent surveys of hospital-wide isolates from Germany. Resistance patterns seen from the ICU suggest that prescribing doctrine be reappraised to limit practices engendering resistance to large families of related antibiotics.