title: Clinical features and outcome of postoperative peritonitis following bariatric surgery.
abstract: BACKGROUND
  We assessed the clinical features and outcome of morbidly obese patients admitted to the intensive care unit (ICU) for management of postoperative peritonitis (POP) following bariatric surgery (BS).
  
  
  METHODS
  In a prospective, observational, surgical ICU cohort, we compared the clinical features, empiric antibiotic therapy, and prognosis of BS patients with those developing POP after conventional surgery (cPOP).
  
  
  RESULTS
  Overall, 49 BS patients were compared to 134 cPOP patients. BS patients were younger (45 ± 10 versus 63 ± 16 years; p < 0.0001), had lower rates of fatal underlying disease (39 vs. 64%; p = 0.002), and the same SOFA score at the time of reoperation (8 ± 4 vs 8 ± 3; p = 0.8) as the cPOP patients. BS patients had higher proportions of Gram-positive cocci (48 vs. 35 %; p = 0.007) and lower proportions of Gram-negative bacilli (33 vs. 44%; p = 0.03), anaerobes (4 vs. 10%; p = 0.04), and multidrug-resistant strains (20 vs. 40%; p = 0.01). Despite higher rates of adequate empiric antibiotic therapy (82 vs. 64%; p = 0.024) and high de-escalation rates (67% in BS cases and 51% in cPOP cases; p = 0.06), BS patients had similar reoperation rates (53 vs. 44%; p = 0.278) and similar mortality rates (24 vs. 32%; p = 0.32) to cPOP patients. In multivariate analysis, none of the risk factors for death were related to BS.
  
  
  CONCLUSIONS
  The severity of POP in BS patients resulted in high mortality rates, similar to the results observed in cPOP. Usual empiric antibiotic therapy protocols should be applied to target multidrug-resistant microorganisms, but de-escalation can be performed in most cases.
authors.affiliation: Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75018, Paris, France, philippe.montravers@bch.aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.forename: Jean
authors.initials: J
authors.lastname: Guglielminotti
authors.forename: Nathalie
authors.initials: N
authors.lastname: Zappella
authors.forename: Mathieu
authors.initials: M
authors.lastname: Desmard
authors.forename: Claudette
authors.initials: C
authors.lastname: Muller
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.forename: Guillaume
authors.initials: G
authors.lastname: Dufour
authors.forename: Pascal
authors.initials: P
authors.lastname: Augustin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D010538:Peritonitis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents