title: Basis for selecting optimum antibiotic regimens for secondary peritonitis.
abstract: Adequate management of severely ill patients with secondary peritonitis requires supportive therapy of organ dysfunction, source control of infection and antimicrobial therapy. Since secondary peritonitis is polymicrobial, appropriate empiric therapy requires combination therapy in order to achieve the needed coverage for both common and more unusual organisms. This article reviews etiological agents, resistance mechanisms and their prevalence, how and when to cover them and guidelines for treatment in the literature. Local surveillances are the basis for the selection of compounds in antibiotic regimens, which should be further adapted to the increasing number of patients with risk factors for resistance (clinical setting, comorbidities, previous antibiotic treatments, previous colonization, severity…). Inadequate antimicrobial regimens are strongly associated with unfavorable outcomes. Awareness of resistance epidemiology and of clinical consequences of inadequate therapy against resistant bacteria is crucial for clinicians treating secondary peritonitis, with delicate balance between optimization of empirical therapy (improving outcomes) and antimicrobial overuse (increasing resistance emergence).
authors.affiliation: a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.affiliation: b PRISM-AG , Madrid , Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Gimenez
authors.affiliation: a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
authors.affiliation: b PRISM-AG , Madrid , Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
mesh_terms: D034841:Abdominal Cavity / Q000382:microbiology / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015780:Carbapenems / Q000627:therapeutic use; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D000078304:Tigecycline
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones; D000078304:Tigecycline; D008911:Minocycline
keywords: E. coli; ESBL; Secondary peritonitis; carbapenemase; carbapenems; combination therapy; critically ill patients; postoperative peritonitis; tigecycline; β-lactam/β-lactamase inhibitors