Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis

Abstract

Introduction: The risk factors associated with poor outcome in generalized peritonitis are still debated. Our aim was to analyze clinical and bacteriological factors associated with the occurrence of shock and mortality in patients with secondary generalized peritonitis.

Methods: This was a prospective observational study involving 180 consecutive patients with secondary generalized peritonitis (community-acquired and postoperative) at a single center. We recorded peri-operative occurrence of septic shock and 30-day survival rate and analyzed their associations with patients characteristics (age, gender, SAPS II, liver cirrhosis, cancer, origin of peritonitis), and microbiological/mycological data (peritoneal fluid, blood cultures).

Results: Frequency of septic shock was 41% and overall mortality rate was 19% in our cohort. Patients with septic shock had a mortality rate of 35%, versus 8% for patients without shock. Septic shock occurrence and mortality rate were not different between community-acquired and postoperative peritonitis. Age over 65, two or more microorganisms, or anaerobes in peritoneal fluid culture were independent risk factors of shock. In the subgroup of peritonitis with septic shock, biliary origin was independently associated with increased mortality. In addition, intraperitoneal yeasts and Enterococci were associated with septic shock in community-acquired peritonitis. Yeasts in the peritoneal fluid of postoperative peritonitis were also an independent risk factor of death in patients with septic shock.

Conclusions: Unlike previous studies, we observed no difference in incidence of shock and prognosis between community-acquired and postoperative peritonitis. Our findings support the deleterious role of Enterococcus species and yeasts in peritoneal fluid, reinforcing the need for prospective trials evaluating systematic treatment against these microorganisms in patients with secondary peritonitis.

Figure 1

Survival according to biliary or non-biliary origin of peritonitis with septic shock.

Figure 2

Proportion of microorganisma isolated from peritoneal fluid culture in community-acquired peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 42; no shock: n = 70). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.

Figure 3

Proportion of microorganisma isolated from peritoneal fluid culture in postoperative peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 32; no shock: n = 36). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.

Figure 4

Survival according to presence of yeasts in postoperative peritonitis.