Laura Gavril Ionela-Alina Grosu Lavinia Bodescu Amancei Ioana Grigoraș

Abstract

A 59 year-old male patient diagnosed with cecal cancer, surgically treated - right hemicolectomy with ileotransverse anastomosis suddenly presented in the 5th postoperative day fever, hypotension, abdominal pain, and vomiting faeces. The intraoperatory diagnosis was postoperative peritonitis due to anastomotic leak; exploratory laparotomy, segmental colectomy, transverse ileostomy, lavage and drainage were performed. Before surgical reintervention, blood cultures were performed and empirical antiinfective therapy was started using ertapenem, vancomycin and fluconazole. A postoperative ICU admission was decided due to septic shock and MODS: acute respiratory failure, acute cardio-circulatory failure, coagulopathy and metabolic acidosis, which required complex treatment: ventilatory support, haemodynamic optimization, antibiotics, analgesia, deep venous thromboembolism prophylaxis, nutrition. In the 3rd day after reintervention, microbiological examination of the intraoperatory collected peritoneal fluid identified a triple germ association: Escherichia coli, Enterococcus faecalis and Proteus mirabilis, which were sensitive to the chosen antibiotics; the blood cultures were sterile. After 3 days of severe evolution, the multiple organ dysfunction gradually improved and the patient was discharged from ICU 10 days later.

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Keywords

postoperative polymicrobial peritonitis, Ertapenem, Carmeli Score, MODS septic shock

References
1. Mimili M, Agca B, Altinli E, Dinc M: Importance of source control in secondary peritonitis. Ulus Travma Derg, 2002, 8(1):49-52.
2. Ozguc H, Yilmazlar T, Gurluler E, Ozen Y, Korun N, Zorluoglu A: Staged abdominal repair in the treatment of intra-abdominal infection: analysis of 102 patients. J Gastrointest Surg, 2003, 7(5):646-651.
3. Agalar F, Eroglu E, Bulbul M, Agalar C, Tarhan OR, Sari M: Staged abdominal repair for treatment of moderate to severe secondary peritonitis. World J Surg, 2005, 29(2):240-244.
4. Teichmann W, Pohland C, Mansfeld T, Herbig B: Peritonitis: attempt to evaluate therapeutic surgical options. Chirurg, 2008, 79(4):282-289.
5. Karamarkovic AR, Popovic NM, Blagojevic ZB et al.: Damage control surgery in abdominal trauma. Acta Chir Iugosl, 2010, 57(1):15-24.
6. Wittmann DH: Treatment of Peritonitis: Antibiotic concentration dynamics at the site of infection as criterion of antimicrobial chemotherapy. Habilitation. Hamburg: Medizinische Fakultät der Universität; 1984.
7. Nicolau DP, Carmeli Y, Crank CW, et al: Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence. Int J Antimicrob Agents, 2012, 39(1):11-15.
8. Carmeli Y, Lidji SK, Shabtai E, Navon Venezia S, Schwaber MJ: The effects of group 1 versus group 2 carbapenems on imipenem resistant Pseudomonas aeruginosa: an ecological study. Diagn Microbiol Infect Dis, 2011, 70:367–372.
9. Solomkin JS, Mazuski JE, Bradley JS et al: Diagnosis and management of complicated intra-abdominal infection in adults and childreans: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50:133-164.
10. Swenson BR, Metzger R, Hedrick TL, et al: Choosing antibiotics for intra-abdominal infections: what do we mean by “high risk”? Surg Infect (Larchmt), 2009, 10:29–39.
11. Sartelli M, Catena F, Coccolini F, Pinna AD: Antimicrobial management of intra-abdominal infections: Literature's guidelines. World J Gastroenterol, 2012, 18(9): 865-871.
12. Falagas ME, Peppas G, Makris GC, Karageorgopoulos DE, Matthaiou DK: Meta-analysis: ertapenem for complicated intra-abdominal infections. Aliment Pharmacol Ther, 2008, 27(10):919-931.
How to Cite
Gavril, L., Grosu, I.-A., Bodescu Amancei, L., & Grigoraș, I. (2014). The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report. Archive of Clinical Cases, 1(1), Arch Clin Cases 2014; 1(1):18-22. https://doi.org/10.22551/2014.01.0101.10005
Section
Case Reports

How to Cite

Gavril, L., Grosu, I.-A., Bodescu Amancei, L., & Grigoraș, I. (2014). The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report. Archive of Clinical Cases, 1(1), Arch Clin Cases 2014; 1(1):18-22. https://doi.org/10.22551/2014.01.0101.10005