FIRST-LINE MEROPENEM ANTIBIOTIC THERAPY IN ACUTE PERITONITIS SECONDARY TO COLIC PERFORATION. CLINICAL AND HISTOPATHOLOGICAL STUDY ON THE LABORATORY ANIMAL
Abstract
Acute peritonitis accounts for 1% of all on-call visits and is the second leading cause of sepsis worldwide. Annually, due to secondary peritonitis, it is estimated that 20 million years of life are lost, 25 million years are adjusted for disabilities and 896,000 deaths. Fecal peritonitis is one of the most common causes of intensive care admissions with a mortality rate between 19.1 and 31.6% in some centers exceeding 50%. Material and methods: Taking into account the above, we imagined a study, using laboratory animals, in which we produced sigmoid perforations, then followed their evolution without antibiotic treatment and under antibiotic therapy with Cefuroxime 25 mg/kg/24 hours intravenously or Meropenem 40 mg/kg intravenously, following the tissue changes both macroscopically and microscopically. Results: Our study revealed a mortality rate of 3.33%, the death occurring within 72 hours from the time of perforation. By observing the general condition (clinical point of view), no major differences between batches were found, neither from a macroscopic point of view (inspection of the peritoneal cavity). After microscopic analysis of the peritoneum and sigmoid colon meropenem treatment showed remarkably better results, especially at T4. Conclusions: Meropenem is a first-line antibiotic in acute peritonitis secondary to colonic perforation, which together with surgery can reduce the morbidity and mortality of this pathology.
References
2. Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg 2012; 110(2): 139-149 / doi: 10.1177/1457496920984078.
3. Tridente A, et al. Patients with fecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Intensive Care Med 2014; 40(2): 202-210 / doi: 10.1007/ s00134-013-3158-7.
4. Scholefield JH, Wyman A, Rogers K. Management of generalized fecal peritonitis-can we do better?, J R Soc Med 1991; 84(11): 664-666.
5. Paul V, Tridente A, Kaur P, Mahmood M, Mellors R, Raithatha AH. Critically ill patients with fecal peritonitis: a 5-year review in a tertiary centre Crit. Care 2015; 19(1): P374 / doi: 10.1186/cc14454.
6. Roth F, Leedahl ND, Leedahl DD, Guerrero DM. Clinical and Financial Impact of Rapid Antimicrobial Susceptibility Testing in Blood Cultures. Antibiot (Basel, Switzerland) 2022: 11(2) / doi: 10.3390/antibiotics11020122.
7. Eckmann C, Bassetti M. Prognostic factors for mortality in (fecal) peritonitis: back to the roots!, Intensive Care Med 2014; 40(2): 269-271 / doi: 10.1007/s00134-013-3155-x.
8. de S. Pires B, Azevedo IM, Moreira MDCF, Celani LMS, Medeiros AC. Effect of Peritoneal Lavage with Coconut Water in Healing of Colon Anastomosis in Rat Abdominal Sepsis Model. J Surg Clin Res 2017; 8(1): 26 / doi: 10.20398/jscr.v8i1.13033.
9. Ordoñez CA, Puyana JC. Management of peritonitis in the critically ill patient. Surg Clin North Am 2006; 86(6): 1323-1349 / doi: 10.1016/j.suc.2006.09.006.
10. Kumar A, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136(5): 1237-1248 / doi: 10.1378/chest.09-0087.
11. Türkan F, Huyut Z, Taslimi P, Gülçin I. The in vivo effects of cefazolin, cefuroxime, and cefoperazon on the carbonic anhydrase in different rat tissues. J Biochem Mol Toxicol 2018; 32(3): e22041 / doi: 10.1002/jbt.22041.
12. Mascena GV, Melo MCSC, Gadelha DNB, Oliveira TKB, Brandt CT. Severe autogenously fecal peritonitis in ageing Wistar rats. Response to intravenous meropenem. Acta Cir Bras 2014; 29(9): 615-621 / doi: 10.1590/s0102-8650201400150010.
13. Bielecki K, Kamiński P, Klukowski M. Large bowel perforation: morbidity and mortality. Tech. Coloproctol 2002; 6(3): 177-182 / doi: 10.1007/s101510200039.
14. Doklestić K, et al. Secondary peritonitis-evaluation of 204 cases and literature review. J Med Life 2014; 7(2): 132-138.
15. Biondo S, et al. Prognostic factors for mortality in left colonic peritonitis: a new scoring system11No competing interests declared. J Am Coll Surg 2000; 191(6): 635-642 / doi.org/ 10.1016/S1072-7515 (00)00758-4.
16. Tariq M, Moutaery AA, Arshaduddin M, Khan HA, Evans DP, Jacobs S. Fluconazole attenuates lung injury and mortality in a rat peritonitis model, Intensive Care Med 2003; 29(11): 2043-2049 / doi: 10.1007/s00134-003-1960-3.
17. Brocco MC, et al. Effects of peritoneal lavage with lidocaine on survival of rats with fecal. Acta Cir Bras 2008; 23(1): 42-47 / doi: 10.1590/s0102-86502008000100008.
18. Brocco MC, et al. Histological features of peritoneal lavage with ropivacaine in rats with fecal peritonitis. Acta Cir Bras 2012; 27(2): 193-199 / doi: 10.1590/s0102-86502012000200016.
19. Brocco MC, Nagib D, Paulo S, Florêncio J, Baptista DA, Carraretto AR. Effects of Peritoneal Lavage with Bupivacaine on Survival of Mice with Fecal Peritonitis. Rev Bras Anestesiol 2008; 58(5): 474-479 / doi: 10.1590/S0034-70942008000500005.
20. Weinstein WM, Onderdonk AB, Bartlett JG, Gorbach SL. Experimental Intra-Abdominal Abscesses in Rats: Development of an Experimental Model. Infect Immun 1974; 10(6): 1250-1205 / doi: 10.1128/iai.10.6.1250-1255.1974.
21. García Olmo D, et al. Physiopathology of paralytic ileus secondary to chemical peritonitis. Experimental study in dogs. Rev Es Enferm Apar Dig 1989; 76(4): 307-315.
22. Weledji EP. Perspectives on paralytic ileus. Acute Med Surg 2020; 7(1): e573 / doi: 10.1002/ams2. 573.
23. Schwarz NT, Beer-Stolz D, Simmons RL, Bauer AJ. Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis. Ann Surg 2002; 235(1): 31-40 / doi: 10.1097/00000658-200201000-00005.
24. Vather R, O’Grady, Bissett IP, Dinning PG. Postoperative ileus: mechanisms and future directions for research. Clin Exp Pharmacol Physiol 2014; 41(5): 358-370 / doi: 10.1111/1440-1681.12220.
25. Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag 2008; 4(5): 913-917 / doi: 10.2147/tcrm.s2390.
26. Harnsberger CR, Mayke JAl, K. Alavi K. Postoperative Ileus. Clin Colon Rectal Surg 2019; 32(3): 166-170 / doi: 10.1055/s-0038-1677003.
27. Knightly JJ, Agostino D, Cliffton EE. The effect of fibrinolysin and heparin on the formation of peritoneal adhesions. Surgery 1962; 52: 250-258.
28. Kayaoglu HA, Ozkan N, Yenidogan E, Koseoglu RD. Effect of Antibiotic Lavage in Adhesion Prevention in Bacterial Peritonitis. Turkish J Trauma Emerg Surg 2013; 19(3): 189-194 / doi: 10.5505/ tjtes.2013.63444.
29. Topley N, Williams JD. Role of the peritoneal membrane in the control of inflammation in the peritoneal cavity. Kidney Int Suppl 1994; 48: S71-S78.
30. van Baal JOA, et al. The histophysiology and pathophysiology of the peritoneum, Tissue Cell 2017; 49(1): 95-105 / doi: https://doi.org/10.1016/j.tice.2016.11.004.
31. Faull RJ. Peritoneal defenses against infection: winning the battle but losing the war? Semin Dial 2000; 13(1): 47-53 / doi: 10.1046/j.1525-139x.2000.00013.x.
32. Topley N, et al. Human peritoneal mesothelial cell prostaglandin synthesis: Induction of cyclooxygenase mRNA by peritoneal macrophage-derived cytokines. Kidney Int 1994; 46(3): 900-909 / doi.10.1038/ki.1994.348.
33. Jonjić N, et al. Expression of adhesion molecules and chemotactic cytokines in cultured human mesothelial cells., J Exp Med 1992; 176(4): 1165-1174 / doi: 10.1084/jem.176.4.1165.
34. Li FK, et al., “Leukocyte migration across human peritoneal mesothelial cells is dependent on directed chemokine secretion and ICAM-1 expression, Kidney Int 1998; 54(6): 2170-2183 / doi: doi.org/ 10.1046/j.1523-1755.1998.00174.x.
35. Mazar J, et al. CD40 ligand (CD154) takes part in regulation of the transition to mononuclear cell dominance during peritonitis, Kidney Int 2005; 67(4): 1340-1349 / doi: https://doi.org/10.1111/j.1523-1755.2005.00211.x.
36. Witowski J, Kawka E, Rudolf A, Jörres A. New Developments in Peritoneal Fibroblast Biology: Implications for Inflammation and Fibrosis in Peritoneal Dialysis, Biomed Res Int 2015; 2015: 134708 / doi: 10.1155/2015/134708.
37. Jasper CAJJ, Kieft H, Speelberg B, et al. Meropenem versus Cefuroxime plus Gentamicin for Treatment of Serious Infections in Elderly Patients. Antimicrob Agents Chemother 1998; 42(5): 1233-1238 / doi:10.1128/AAC.42.5.1233.
38. Törnqvist A, Forsgrent A, Leandoer L , Ursing J. Antibiotic treatment during surgery for diffuse peritonitis: A prospective randomized study comparing the effects of cefuroxime and of a cefuroxime and metronidazole combination. Br J Surg 1985; 72(4): 261-264 / doi: 10.1002/bjs.1800720404.
Additional Files
Published
Issue
Section
License
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form