Peritonitis, bacterial secondary

Peritonitis may be classified as primary, secondary, or tertiary. Primary peritonitis, also called spontaneous bacterial peritonitis, is an infection of the peritoneal cavity without an evident source of bacteria from the abdomen.1,2 In secondary peritonitis, a focal disease process is evident within the abdomen. Secondary peritonitis may involve perforation of the gastrointestinal (GI) tract (possibly because of ulceration, ischemia, or obstruction), postoperative peritonitis, or posttraumatic peritonitis (e.g., blunt or penetrating trauma). Tertiary peritonitis occurs in critically ill patients and is infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis. 

Primary peritonitis is treated with antimicrobials and rarely requires drainage. Secondary peritonitis requires surgical removal of the inflamed or gangrenous tissue to prevent further bacterial contamination. If the surgical procedure is sub-optimal, attempts are made to provide drainage of the infected or gangrenous structures. 

Dougherty SH. Antimicrobial culture and susceptibility testing has little value for routine management of secondary bacterial peritonitis. Clin Infect Dis 1997 25(suppl 2) S258-261. 

Peritoneal dialysis Cirrhosis with ascites Nephrotic syndrome Secondary bacterial peritonitis... 

Intraabdominal infections have a wide spectrum of clinical features often depending on the specific disease process, the location and the magnitude of bacterial contamination, and concurrent host factors. Patients with primary and secondary peritonitis present quite differently (Table 42-3). 

Intraabdominal infections have a wide spectrum of clinical features often depending on the specific disease process, the location and the magnitude of bacterial contamination, and concurrent host factors. Patients with primary and secondary peritonitis present quite differently (Table 42-3). If peritonitis continues untreated, the patient may experience hypovolemic shock from fluid loss into the peritoneum, bowel wall, and lumen. This may be accompanied by generalized sepsis. Intraabdominal abscess may pose a diagnostic challenge as the symptoms are neither specific nor dramatic. 

Each of these 3 forms of SBP has to be delimited from secondary bacterial peritonitis. In bacterial ascites, several types of microorganisms, including fungi, can usually be identified after subculturing. As a rule, the cell count exceeds 10,000/mm, the LDH value is elevated (> 225 U/1), and the glucose concentration is < 50 mg/dl. 

Akriviadis, A., Runyon, B.A. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990 98 127-133... 

Secondary bacterial peritonitis, ascitic fluid infection caused by a treatable intra-abdominal source, can masquerade as SBP and should be considered when multiple or atypical organisms are cultured, a very high ascitic fluid PMN count is seen, or in patients who fail to respond to appropriate antibiotic therapy. Uncomplicated SBP usually responds rapidly to appropriate therapy and the 48-hour PMN count, if obtained, is predictably lower than the initial count. In this setting a follow-up paracentesis revealing a PMN count that continues to rise despite antibiotic therapy can be helpful in detecting secondary peritonitis. ... 

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