SELECTION OF EMPIRIC ANTIBIOTICS IN TREATMENT OF SECONDARY PERITONITIS CAUSED BY GASTROINTESTINAL LESION

Abstract

Background: Secondary peritonitis is a common diagnosis requiring emergency intervention. Source control with antibiotic therapy are the basic treatments for secondary peritonitis. Antibiotics used in the treatment of secondary peritonitis are usually empiric antibiotics. However, due to increasing microbial resistance, appropriate antibiotic treatment is becoming more and more difficult, especially empiric antibiotic. Some previous studies have shown the role of appropriate antibiotics in the treatment of secondary peritonitis, but conflicts still exist.

Objective: The study evaluates the current status of empiric antibiotic for purpose in improving the effectiveness of empiric antibiotics used in treatment of secondary peritonitis caused by gastrointestinal lesion.

Methods: Retrospective, complete sampling. Patients were treated secondary peritonitis at Gia Dinh People's Hospital with source control and empiric antibiotics were included in the data. We collected information about the microflora in secondary peritonitis (caused by the gastrointestinal lesion) and the rate of inappropriate use of empiric antibiotics then evaluated the impact of inappropriate empiric antibiotics on treatment outcomes. Treatment outcomes include: mortality, surgical site infection, rate of second-line antibiotic requiring due to adverse treatment progress.

Results: During the period January 1, 2021 - December 31, 2022, 256 patients met the selection criteria. Factors affect the mortality rate are age, location of the lesions, ASA score and comorbidity. Lesions in the lower gastrointestinal tract account for the majority of secondary peritonitis caused by the gastrointestinal lesions (84.4%). Escherichia coli is the most common agent in secondary peritonitis caused by the gastrointestinal lesions. The rate of inappropriate antibiotic use is 38.3%. There is a statistically significant difference between the rate of patients with poor treatment response and requiring a change in antibiotic treatment in the appropriate and inappropriate antibiotic use groups (17.3% and 10.2%, p = 0.02). There was no statistically significant difference in mortality rate (p = 0.37) and surgical site infections (p = 0.06) between the above two groups of patients.

Conclusions: Inappropriate empiric antibiotics does not affect the mortality rate, the rate of surgical site infections. Inappropriate empiric antibiotics increases the rate of second-line antibiotic requiring. However, the study only generally evaluated the impact of inappropriate antibiotic on outcome in the group of patients with secondary peritonitis and did not specifically evaluate the group of patients with organ failure due to secondary peritonitis.

Keywords: secondary peritonitis, E. coli, gastrointestinal tract, empiric antibiotics