title: Therapeutic management of peritonitis: a comprehensive guide for intensivists.
abstract: OBJECTIVE
  The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) bacteria.
  
  
  METHODS
  A multidisciplinary panel summarizes the latest advances in the therapeutic management of these critically ill patients.
  
  
  RESULTS
  Appendicitis, cholecystitis and bowel perforation represent the majority of all community-acquired infections, while most cases of healthcare-associated infections occur following suture leaks and/or bowel perforation. The micro-organisms involved include a spectrum of Gram-positive and Gram-negative bacteria, as well as anaerobes and fungi. Healthcare-associated infections are associated with an increased likelihood of MDR pathogens. The key elements for success are early and optimal source control and adequate surgery and appropriate antibiotic therapy. Drainage, debridement, abdominal cleansing, irrigation, and control of the source of contamination are the major steps to ensure source control. In life-threatening situations, a "damage control" approach is the safest way to gain time and achieve stability. The initial empirical antiinfective therapy should be prescribed rapidly and must target all of the micro-organisms likely to be involved, including MDR bacteria and fungi, on the basis of the suspected risk factors. Dosage adjustment needs to be based on pharmacokinetic parameters. Supportive care includes pain management, optimization of ventilation, haemodynamic and fluid monitoring, improvement of renal function, nutrition and anticoagulation.
  
  
  CONCLUSIONS
  The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.
authors.affiliation: APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Université Denis Diderot, PRESS Sorbonne Cité, Paris, France. philippe.montravers@aphp.fr.
authors.forename: P
authors.initials: P
authors.lastname: Montravers
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.|Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Blot
authors.affiliation: Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Peine, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Eckmann
authors.affiliation: Department of Intensive Care Medicine and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Eggimann
authors.affiliation: Department of Endocrine and Head and Neck Surgery, Corporació Sanitaria del Parc Tauli, University Hospital, Sabadell, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Guirao
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal.|Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: J A
authors.initials: JA
authors.lastname: Paiva
authors.affiliation: Department of Surgery, Catholic University of Sacred Heart, Policlinico A Gemelli, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sganga
authors.affiliation: Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: De Waele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000592:standards* / Q000627:therapeutic use*; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Fungal infection; Intra-abdominal hypertension; Multidrug-resistant bacteria; Peritonitis; Postoperative complications; Source control