Poor Outcome of Generalized Peritonitis linked to Enterococcus Species and Yeasts

A new study has found that the detection of Enterococcus species and yeasts in peritoneal fluid can be associated with poor outcomes in patients with secondary generalized peritonitis.

Researchers at Hôpital Lariboisière (Paris, France) prospectively compared the outcomes of 180 consecutive adult patients with community-acquired or postoperative peritonitis who were seen at the medical center over a six-year period; secondary generalized peritonitis was surgically confirmed in all cases. The frequency of septic shock was 41% and the overall mortality rate was 19%; among those who developed septic shock, the mortality was 35%, compared with 8% among patients who did not develop septic shock. The researchers then investigated the factors that predicted septic shock and mortality in these patients.


The researchers found that mortality was not different between patients with community-acquired and postoperative peritonitis, a finding that is counter to some previous published reports, which have typically found that postoperative peritonitis is the more severe type. Other risk factors for septic shock included age of more than 65 years, detection of two or more microorganisms in the peritoneal fluid, and anaerobes in peritoneal fluid. Among patients with septic shock, biliary origin was also associated with increased mortality. However, detection of intraperitoneal yeasts and Enterococci were associated with septic shock in community-acquired peritonitis, and yeasts in the peritoneal fluid of patients with postoperative peritonitis and septic shock were an independent risk factor for death. The study was published on June 24, 2009, in the online edition of Critical Care.

"The outcomes of patients with postoperative and community-acquired peritonitis may have depended more on management than on the pathophysiological process,” said lead author Bernard Cholley, M.D., of the department of anesthesiology and intensive care. "These findings reinforce the need for prospective trials evaluating systemic treatment against these microorganisms in patients with secondary peritonitis.”

The researchers noted that although it is generally accepted that the prognosis for postoperative peritonitis is worse than for community-acquired peritonitis, the data on which this notion is based are rather frail. For example, the time elapsed between peritoneal contamination and surgery, which is very difficult to measure precisely, may actually be longer for postoperative peritonitis than for community-acquired peritonitis, which is usually operated on soon after admission.

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