title: Epidemiology, management, and prognosis of secondary non-postoperative peritonitis: a French prospective observational multicenter study.
abstract: BACKGROUND
  Despite improvements in treatment, secondary peritonitis still is associated with high morbidity and mortality rates. Better knowledge of real-life clinical practice might improve management.
  
  
  METHODS
  Prospective, observational study (January-June 2005) of 841 patients with non-postoperative secondary peritonitis.
  
  
  RESULTS
  Peritonitis originated in the colon (32% of patients), appendix (31%), stomach/duodenum (18%), small bowel (13%), or biliary tract (6%). Most patients (78%) presented with generalized peritonitis and 26% with severe peritonitis (Simplified Acute Physiology Score [SAPS] II score>38). Among the 841 patients, 27.3% underwent laparoscopy alone; 11% underwent repeat surgery, percutaneous drainage, or both. A SAPS II score>38 and the presence of Enterococcus spp. were predictive of abdominal and non-surgical infections (odds ratio [OR]=1.84; p=0.013 and OR=2.93; p<0.0001, respectively). A SAPS II score>38 also was predictive of death (OR=10.5; p<0.0001). The overall mortality rate was high (15%). Patients receiving inappropriate initial antimicrobial therapy had significantly higher morbidity and mortality rates than patients receiving appropriate therapy (44 vs. 30%; p=0.004 and 23% vs. 14%; p=0.015, respectively). The SAPS II score and rates of severe peritonitis, morbidity, and mortality were significantly lower in patients with appendiceal peritonitis.
  
  
  CONCLUSIONS
  Patients with non-postoperative peritonitis should be considered high risk and should receive appropriate initial therapy. The presence of Enterococcus spp. in peritoneal cultures significantly increased morbidity but not the mortality rate. Appendiceal peritonitis that was less severe and had a better prognosis than peritonitis originating in other sites should be considered a special case in future studies.
authors.affiliation: Département d'Anesthésie Réanimation, Assistance Publique Hôpitaux de Paris, CHU Hôtel-Dieu, Paris, France. remy.gauzit@htd.aphp.fr
authors.forename: Rémy
authors.initials: R
authors.lastname: Gauzit
authors.forename: Yves
authors.initials: Y
authors.lastname: Péan
authors.forename: Xavier
authors.initials: X
authors.lastname: Barth
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mistretta
authors.forename: Olivier
authors.initials: O
authors.lastname: Lalaude
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D005260:Female; D005602:France / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents