Risk factors associated with intraabdominal infections: a prospective multicenter study

Introduction methods: A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic managemen t and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the stu dy were 355 patients with macroscopically confirmed peritonitis. Results: I n the univariate analysis, the following factors influenced both the mortal ity and the incidence of postoperative complications: age, presence of cert ain concomitant disease, site of origin of peritonitis, type of admission a nd the ability of the surgeon to eliminate the source of infection. In addi tion, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II(P<0.0 01), successful operation (P<0.001), age (P<0.001), liver disease (P<0.03), malignant disease (P<0.04) and renal disease (P<0.05) turned out to be sig nificant with respect to death. Escherichia coli was the predominant organi sm (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adeq uate treatment of enterococci than patients with adequate treatment or no e nterococci (P<0.05). Conclusion: The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is no t adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome.