title: Management and outcome of high-risk peritonitis: a retrospective survey 2005-2009.
abstract: OBJECTIVE
  To describe the clinical and microbiological aspects of high-risk peritonitis and to analyze their impact on its outcome.
  
  
  METHODS
  This was a retrospective review of all culture-positive peritonitis between October 1, 2005 and September 30, 2009. In accordance with recent Infectious Diseases Society of America (IDSA) guidelines, a group of high-risk peritonitis patients was selected based on age, severity of illness, underlying diseases, and acquisition of the infection.
  
  
  RESULTS
  Ninety-three patients with high-risk peritonitis were studied; these patients were divided into subgroups of those with community-associated disease (14%) and those with healthcare-associated disease (86%). The median age of patients was 66 (interquartile range (IQR) 22-95) years. The 30-day mortality rate was 25%. Subgroups differed in age (p=0.011), degree of comorbidity (p=0.023), severity of peritonitis (p=0.036), admission to the intensive care unit (ICU) (p=0.002), length of ICU stay (p<0.001), length of hospital stay (p<0.001), cure at day 30 (p=0.001), and adequate treatment (p=0.042). The microbiological etiology and resistance profiles were similar between the patient groups. Adequate empirical treatment was not related to a better outcome. Severity of disease (p=0.005) and the presence of enterococci (p=0.044) were independently associated with mortality.
  
  
  CONCLUSIONS
  The mode of acquisition influences severity and certain parameters of outcome in high-risk peritonitis, but not its microbiological etiology. The outcome seems to depend primarily on severity of peritonitis and much less on the adequacy of treatment.
authors: Infection Control Unit, Brugmann University Hospital, Brussels, Belgium. caroline.theunissen@chu-brugmann.be
authors: Caroline
authors: C
authors: Theunissen
authors: Soraya
authors: S
authors: Cherifi
authors: Rafik
authors: R
authors: Karmali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001530:Belgium; D017714:Community-Acquired Infections / Q000382:microbiology; D003428:Cross Infection / Q000382:microbiology; D019468:Disease Management; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D017408:Guidelines as Topic; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents