ICU · GI & nutrition / surgical

Abdominal Sepsis & Peritonitis — Source Control, SBP & the Polymicrobial

Also known as Peritonitis · Abdominal sepsis · Intra-abdominal sepsis · Spontaneous bacterial peritonitis · SBP · Secondary peritonitis · Tertiary peritonitis · Source control · Peritonism · Piperacillin-tazobactam · Metronidazole · Complicated intra-abdominal infection · cIAI · Damage control laparotomy · Mannheim Peritonitis Index · Hepatorenal syndrome

The peritonitis is the inflammation of the peritoneum, usually from the intra-abdominal infection; the abdominal sepsis is the sepsis from the intra-abdominal source. The three types: the primary (the spontaneous bacterial peritonitis — the SBP in the cirrhosis and the ascites, the monomicrobial, the ascitic PMN over 250 cells per cubic mm, the cefotaxime plus the albumin), the secondary (the GI perforation or the ischaemia, the polymicrobial — the Gram-negative and the anaerobes, the source control plus the antibiotics), and the tertiary (the persistent or the recurrent after 48 hours of the failed initial treatment, the resistant — the Enterococcus, the Candida, the MDR organisms). The diagnosis: the peritonism (the rigid abdomen, the guarding, the rebound), the CT (the gold standard — the free gas, the fluid, the source), the lactate, the cultures. The management: the Sepsis-6 bundle, the broad antibiotics (the piperacillin-tazobactam ± the vancomycin ± the antifungal, or the ceftriaxone plus the metronidazole or the meropenem), the duration 4 to 7 days after the source control, and the SOURCE CONTROL (the surgery or the IR — the drainage, the debridement, the repair) — the definitive; the delayed source control worsens the mortality.