Risk factors associated with intraabdominal infections: a prospective multicenter study. Peritonitis Study Group.
METHODS
A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic management and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the study were 355 patients with macroscopically confirmed peritonitis.


RESULTS
In the univariate analysis, the following factors influenced both the mortality and the incidence of postoperative complications: age, presence of certain concomitant disease, site of origin of peritonitis, type of admission and the ability of the surgeon to eliminate the source of infection. In addition, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II (P<0.001), successful operation (P<0.001), age (P<0.001), liver disease (P<0.03), malignant disease (P<0.04) and renal disease (P<0.05) turned out to be significant with respect to death. Escherichia coli was the predominant organism (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adequate treatment of enterococci than patients with adequate treatment or no enterococci (P<0.05).


CONCLUSIONS
The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is not adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome.
Wacha
H
H
Chirurgische Klinik, Hospital zum heiligen Geist, Academic Hospital of the University of Frankfurt, Germany.
Hau
T
T
Dittmer
R
R
Ohmann
C
C
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001439:Bacteroides / Q000302:isolation & purification; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D010538:Peritonitis / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection; D016896:Treatment Outcome