Septic Peritonitis

Excerpt

Sepsis is a pro- and antiinflammatory response that manifests in the body due to the host-pathogen interaction. Excessive inflammation results in collateral tissue injury, and the antiinflammatory response results in immunosuppression, leading to increased susceptibility to secondary infection. The clinical manifestations of sepsis are highly variable, depending on the initial site of infection, the causative organism, the pattern of acute organ dysfunction, the underlying health status of the patient, and the interval before initiation of treatment.

Severe sepsis occurs as a result of both community-acquired and healthcare-associated infections. While pneumonia continues to be the most common cause of sepsis, both are community-associated. In health care settings, intraabdominal and urinary tract infections are important conduits to the pathological systemic response. Staphylococcus aureus and Staphylococcus pneumoniae are the most common gram-positive pathogens, and Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa stand out among the gram-negative microorganisms.

When an infection in the intraabdominal cavity has a primary focus, with identifiable localization, it is called an abscess; when the nidus of the inflammatory response occurs in the serous membrane lining the cavity, it is called peritonitis. Both can lead to a systemic inflammatory/anti-inflammatory response known as peritonitis-induced sepsis. This topic focuses on the fundamental tenets of diagnosing and treating the underlying infection and the complications associated with sepsis (see Image. Severe Septic Peritonitis).