title: Pseudomonas aeruginosa post-operative peritonitis: clinical features, risk factors, and prognosis.
abstract: BACKGROUND
  Postoperative peritonitis (PP) is associated with a high rate of multi-drug-resistant micro-organisms. The role of Pseudomonas aeruginosa in this condition has never been assessed. We evaluated the risk factors and prognosis for PP caused by P. aeruginosa.
  
  
  METHODS
  Patients hospitalized in the intensive care unit (ICU) after re-operation for PP were identified prospectively. Analyses were performed retrospectively. Specific risk factors were investigated by comparing P. aeruginosa PP with PP having other causes. The main outcome endpoint was death in the hospital.
  
  
  RESULTS
  We found 55 P. aeruginosa PP among the 349 cases of PP (16%) in the ICU over 14 years. Factors associated with the presence of P. aeruginosa in peritoneal fluid culture were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.02-1.09; p=0.004) and respiratory failure (OR 2.3; 95% CI 1.26-4.16; p=0.006). These criteria performed poorly in predicting P. aeruginosa PP. Such infections were associated with a higher hospital mortality rate, but not after adjustment for the severity score. Adequate antibiotic therapy comprising two antibiotics effective against P. aeruginosa was associated with a lower mortality rate for P. aeruginosa PP in the ICU.
  
  
  CONCLUSIONS
  The prevalence of P. aeruginosa PP is not high. Risk factors do not allow accurate prediction of the infection. Our data suggest two drugs effective against P. aeruginosa should be considered for treating these infections.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Paris Diderot, Sorbonne Paris Cité and APHP, Hôpital Bichat-Claude Bernard, Paris, France. pascalaugustin@hotmail.com
authors.forename: Pascal
authors.initials: P
authors.lastname: Augustin
authors.forename: Alexy
authors.initials: A
authors.lastname: Tran-Dinh
authors.forename: Nadia
authors.initials: N
authors.lastname: Valin
authors.forename: Mathieu
authors.initials: M
authors.lastname: Desmard
authors.forename: Marie Adeline
authors.initials: MA
authors.lastname: Crevecoeur
authors.forename: Claudette
authors.initials: C
authors.lastname: Muller-Serieys
authors.forename: Paul-Louis
authors.initials: PL
authors.lastname: Woerther
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.forename: Regis
authors.initials: R
authors.lastname: Bronchard
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology*; D015995:Prevalence; D011379:Prognosis; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome