Predictors of recurrence of fulminant bacterial peritonitis after discontinuation of antibiotics in open management of the abdomen.
OBJECTIVE
To assess a scoring system for predicting recurrence of fulminant bacterial peritonitis after discontinuation of antimicrobial treatment in patients being treated by open management of the abdomen for persistent bacterial peritonitis after perforation of the digestive tract, anastomotic disruption, or necrotising pancreatitis.


METHODS
Retrospective study.


METHODS
University Hospital, The Netherlands.


METHODS
58 consecutive patients.


METHODS
Recurrence of fulminant bacterial peritonitis and survival.


RESULTS
13 of the 58 patients (22%) died during the initial course of antimicrobial drugs. 14 of the remaining 45 patients had a recurrence of fulminant bacterial peritonitis after discontinuation of antimicrobial drugs, 4 of whom died. Predictive criteria included raised white cell count (WCC) (p = 0.02), duration of initial antibiotic treatment (p = 0.05), and deterioration in Simplified Acute Physiology Score (p = 0.05). Using the WCC and the duration of initial antimicrobial treatment together with other variables that showed a predictive trend (body temperature, percentage band cells, underlying disease, and use of inotropic agents), in a new scoring system (0-12), fulminant bacterial peritonitis did not recur when the score was 0-3, but in 9 of 11 patients with a score of 6 or more it did (p < 0.001).


CONCLUSIONS
Patients at increased risk of recurrence of fulminant bacterial peritonitis during open management of the abdomen can be identified at the time of discontinuation of antimicrobial treatment by a new scoring system; antimicrobial treatment should not be discontinued in patients with a score of 6 or more.
Visser
M R
MR
Department of Clinical Microbiology, University Hospital Utrecht, The Netherlands.
Bosscha
K
K
Olsman
J
J
Vos
A
A
Hulstaert
P F
PF
van Vroonhoven
T J
TJ
van der Werken
C
C
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control* / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
D000900:Anti-Bacterial Agents