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Peritonitis und abdominelle Sepsis

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Infektionen in der Allgemein- und Viszeralchirurgie

Zusammenfassung

Die Bauchfellentzündung (Peritonitis) ist immer eine potenziell lebensbedrohliche Erkrankung, bei der neben der Infektion an sich auch immunologische Phänomene zur Morbidität und Mortalität beitragen. In diesem Kapitel werden zunächst die verschiedenen Begrifflichkeiten der Peritonitis und der abdominellen Sepsis dargestellt und eingeordnet. Die Herdsanierung als kausaler Therapiebestandteil einschließlich der Frage, ob und welche Spülregimes angewandt werden sollen, sowie die Besonderheiten des Laparostomas werden im Folgenden diskutiert. Schließlich wird die Bedeutung der antiinfektiven Therapie als zweite kausale Säule der Peritonitisbehandlung gewürdigt und beschrieben.

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Literatur

  • Adler SN, Gasbarra DB (2005) A pocket manual of differential diagnosis. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  • Atema J, Gans S, Boermeester M (2015) Systemic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg 39(4):912–25

    Article  CAS  PubMed  Google Scholar 

  • Azuhata T, Kinoshita K, Kawano D et al (2014) Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care 18:R87

    Article  PubMed  PubMed Central  Google Scholar 

  • Bassetti M, Marchetti M, Chakrabarti A et al (2013) A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med 39:2092–2106

    Article  PubMed  Google Scholar 

  • Bassetti M, Righi E, Ansaldi F et al (2015) A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med 41:1601–1610

    Article  PubMed  Google Scholar 

  • Bassetti M, Garnacho-Montero J, Calandra T et al (2017) Intensive care medicine research agenda on invasive fungal infection in critically ill patients. Intensive Care Med 43:1225–1238

    Article  CAS  PubMed  Google Scholar 

  • Bloos F, Thomas-Rüddel D, Rüddel H, Engel C, Schwarzkopf D, Marshall JC, Harbarth S, Simon P, Riessen R, Keh D, Dey K, Weiß M, Toussaint S, Schädler D, Weyland A, Ragaller M, Schwarzkopf K, Eiche J, Kuhnle G, Hoyer H, Hartog C, Kaisers U, Reinhart K (2014) MEDUSA Study Group. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care 18(2):R42. https://doi.org/10.1186/cc13755.

  • Bloos F, Ruddel H, Thomas-Ruddel D et al (2017) Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial. Intensive Care Med 43:1602–1612

    Article  PubMed  Google Scholar 

  • Büchler M, Baer H, Brügger L, Feodorovici M, Uhl W, Seiler C (1997) Chirurgische Therapie der diffusen Peritonitis: Herdsanierung und intraoperative extensive Lavage. Der Chirurg 68:811–815

    Article  Google Scholar 

  • Coccolini et al (2017) The role of open abdomen in non-trauma patient: WSES Consensus Paper. World Journal of Emergency Surgery 12:39

    Google Scholar 

  • Coccolini et al (2018) The open abdomen in trauma and non-trauma patients: WSES Consensus Paper. World Journal of Emergency Surgery 13:7

    Article  PubMed  PubMed Central  Google Scholar 

  • De Waele J, Lipman J, Sakr Y et al (2014) Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome. BMC Infect Dis 14:420

    Article  PubMed  PubMed Central  Google Scholar 

  • Diedrich S, Müller G Sandbrink C, Papke R, van der Linde J, Heidecke CD, Parteke L, Assadian O, Kramer A (2018) Efficiency of Emulsified Particle-Associated Polyhexamethylenbiguanid-Hydrochlorid (Polihexanide) for Peritoneal Lavage in a Murine Sepsis Model. Surg Infect (Larchmt)19(7): 723–728

    Google Scholar 

  • Eckmann C (2016) Antimikrobielle Therapie der Peritonitis im Zeitalter der Multiresistenz. Chirurg 87:26–33

    Article  CAS  PubMed  Google Scholar 

  • Eckmann C, Dryden M, Montravers P et al (2011) Antimicrobial treatment of „complicated“ intra-abdominal infections and the new IDSA guidelines ? A commentary and an alternative European approach according to clinical definitions. Eur J Med Res 16:115–126

    Article  PubMed  PubMed Central  Google Scholar 

  • Eckmann C, Montravers P, Bassetti M et al (2013) Efficacy of tigecycline for the treatment of complicated intra-abdominal infections in real-life clinical practice from five European observational studies. J Antimicrob Chemother. 68 Suppl 2: ii25–35

    Google Scholar 

  • Eckmann C, Kaffarnik M, Schappacher M et al (2018) Multiresistente gramnegative Bakterien: Klinischer Managementpfad für Patienten mit elektiven Eingriffen in der Viszeralchirurgie. Chirurg 89:40–49

    Article  CAS  PubMed  Google Scholar 

  • Gawad K (2013) Verschluss eines Laparostomas. Allgemein- und Viszeralchirurgie up2date 223–233

    Google Scholar 

  • Germer CT, Eckmann C (2016) Peritonitis. Chirurg 87(1):3–4. https://doi.org/10.1007/s00104-015-0118-5.German

    Article  PubMed  Google Scholar 

  • Glitsch A, von Bernstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD (2008) Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy. 40(3):192–199. https://doi.org/10.1055/s-2007-995384 Epub 2008 Jan 14

    Article  CAS  PubMed  Google Scholar 

  • Güsgen C, Schwab R, Willms A (2016) Therapy concepts for diffuse peritonitis: when laparoscopic lavage and when open abdomen? Chirurg 87(1):34–39. https://doi.org/10.1007/s00104-015-0104-y

    Article  PubMed  Google Scholar 

  • Güsgen C, Schwab R, Willms A (2016) Therapiekonzepte der diffusen Peritonitis. Der Chirurg 87:34–39

    Article  Google Scholar 

  • Harris PNA, Tambyah PA, Lye DC et al (2018) Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial. JAMA 2018; 320: 984–994Montravers P, Tubach F, Lescot T et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med 44: 300–310

    Google Scholar 

  • Knaebel H-P, Seiler C, Weigand M, Büchler M (2007) Aktueller Stand der Diagnostik und Therapie der Peritonitis. Zentralblatt Chirurgie 132:419–426

    Article  Google Scholar 

  • Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O (2018) Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol 31:28–58

    Article  CAS  PubMed  Google Scholar 

  • Kruis W, Germer CT, Leifeld L (2014) German Society for Gastroenterology, Digestive and metabolic diseases and The German society for general and visceral surgery. Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery. Digestion 90(3):190–207. doi: https://doi.org/10.1159/000367625.

  • Kujath P, Eckmann C, Esnaashari H, Bruch HP (2007) Die Wertigkeit der Spülbehandlung bei der Peritonitis. Zentralblatt Chirurgie 132:427–432

    Article  CAS  Google Scholar 

  • Lamme B, Boermeester MA, Reitsma J, Mahler C, Obertop H, Gouma D (2002) Meta-Analysis of relaparotomy for secondary peritonitis. Br J Surg 89:1516–1524

    Article  CAS  PubMed  Google Scholar 

  • Lenz S, Doll D, Harder K, Lieber A, Müller U, Düsel W, Siewert J (2006) Verfahren zum temporären Bauchdeckenverschluss bei Trauma und Sepsis. Der Chirurg 77:580–585

    Article  CAS  Google Scholar 

  • Lindner M, Wacha H, Wesch G, Feldmann U (1986) [Welche klinischen Faktoren beeinflussen die Letalität bei bakterieller Peritonitis: Mannheimer Peritonitis-Index (MPI)] Langenbeck’s Archives of Surgery, Bd 369. Springer, Berlin, S 788

    Google Scholar 

  • Lock JF, Eckmann C, Germer CT (2016) Characteristics of postoperative peritonitis. Chirurg 87(1):20–25. https://doi.org/10.1007/s00104-015-0110-0.Review

    Article  CAS  PubMed  Google Scholar 

  • Lünse S, Höhn J, Glitsch A, Keßler W, Simon P, Heidecke CD, Schreiber A (2019) Over-the-Scope Clip Closure of Pancreatico-Colonic Fistula Secondary to Acute or Chronic Pancreatitis: A Case Series. J Laparoendosc Adv Surg Tech A. 29(8):1000–1004. https://doi.org/10.1089/lap.2019.0166 Epub 2019 May 9

    Article  PubMed  Google Scholar 

  • Maier S, Traeger T, Westerholt A, Heidecke CD (2005) Special aspects of abdominal sepsis. Chirurg. 76(9):829–36

    Article  CAS  PubMed  Google Scholar 

  • Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, Chang PK, O’Neill PJ, Mollen KP, Huston JM, Diaz JJ Jr, Prince JM (2017) The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 18(1):1–76. https://doi.org/10.1089/sur.2016.261

    Article  PubMed  Google Scholar 

  • Montravers P, Martin-Loeches I (2019) Source control and intra-abdominal infections: Still many questions and only limited answers. J Crit Care. 52:265–266. https://doi.org/10.1016/j.jcrc.2019.04.022 Epub 2019 Apr 24

    Article  PubMed  Google Scholar 

  • Montravers P, Blot S, Dimopoulos G, Eckmann C et al (2016) Therapeutic management of peritonitis: a comprehensive guide for intensivists. Intensive Care Med 42:1234–1247

    Article  CAS  PubMed  Google Scholar 

  • Perathoner A, Öfner-Velano D (2015) Abdominelles Kompartmentsyndrom, abdominelle Unterdrucktherapie. Eur Surg 47:359–367

    Article  Google Scholar 

  • Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43(3):304–377. https://doi.org/10.1007/s00134-017-4683-6 Epub 2017 Jan 18

    Article  PubMed  Google Scholar 

  • Bodmann KF, Grabein B, Kresken M et al (2018) S2k-Leitlinie der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG). Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2018, aktualisierte Version Juli 2019, AWMF-Register-Nr. 082–006

    Google Scholar 

  • Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, Ceresoli M, Chiara O, Coccolini F, De Waele JJ, Di Saverio S, Eckmann C, Fraga GP, Giannella M, Girardis M, Griffiths EA, Kashuk J, Kirkpatrick AW, Khokha V, Kluger Y, Labricciosa FM, Leppaniemi A, Maier RV, May AK, Malangoni M, Martin-Loeches I, Mazuski J, Montravers P, Peitzman A, Pereira BM, Reis T, Sakakushev B, Sganga G, Soreide K, Sugrue M, Ulrych J, Vincent JL, Viale P, Moore EE (2017) Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 4(12):22. https://doi.org/10.1186/s13017-017-0132-7

    Article  Google Scholar 

  • Schmoch T, Al-Saeedi M, Hecker A, Richter DC, Brenner T, Hackert T, Weigand MA (2019) Evidence-based interdisciplinary treatment of abdominal sepsis. Chirurg 90(5):363–378. https://doi.org/10.1007/s00104-019-0795-6

    Article  CAS  PubMed  Google Scholar 

  • Schmoch T, Al-Saeedi HA, Richter D, Brenner T, Hackert T, Weigand M (2019) Evidenzbasierte, interdisziplinäre Behandlung der abdominellen Sepsis. Chirurg 90:363–378

    Article  CAS  PubMed  Google Scholar 

  • Siewert JR, Stein HJ, Bartels H (2004) Anastomotic leaks in the upper gastrointestinal tract. Chirurg 75(11):1063–1070

    Article  CAS  PubMed  Google Scholar 

  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810. https://doi.org/10.1001/jama.2016.0287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 50:133–164

    Article  PubMed  Google Scholar 

  • Strobel O, Werner J, Büchler M (2011) Chirurgische Therapie der Peritonitis. Chirurg 82:242–248

    Article  CAS  PubMed  Google Scholar 

  • Swank H, Mulder I, Hoofwijk A, Nienhuijs S, Lange J, Bemelman W Early experience with laparoscopic lavage for perforated diverticulitis. Br J Surg 100:704 -710

    Google Scholar 

  • Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. In: Lancet, Band 2, 1974, (S 81–84). PMID 4.136.544.

    Google Scholar 

  • Theisen J, Bartels H, Weiss W, Berger H, Stein HJ, Siewert JR (2005) Current concepts of percutaneous abscess drainage in postoperative retention. J Gastrointest Surg 9(2):280–283

    Article  PubMed  Google Scholar 

  • van de Groep K, Verhoeff TL, Verboom DM, Bos LD, Schultz MJ, Bonten MJM, Cremer OL (2019) MARS consortium. Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection. J Crit Care 52:258–264. https://doi.org/10.1016/j.jcrc.2019.02.029

    Article  PubMed  Google Scholar 

  • van Goor H, Hulsebos R, Bleichrodt R (1997) Complications of planned relaparotomy in patients with severe general peritonitis. Eur J Surg 163:61–66j

    PubMed  Google Scholar 

  • van Ruler O, Boermeester MA (2017) Surgical treatment of secondary peritonitis: A continuing problem. Chirurg 88(Suppl 1):1–6. https://doi.org/10.1007/s00104-015-0121-x PubMed PMID: 26746213

    Article  PubMed  Google Scholar 

  • Vincent JL (996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22(7): 707–10. https://doi.org/10.1007/BF01709751. PMID 8.844.239.

  • Weis S, Dickmann P, Pletz MW, Coldewey SM, Gerlach H, Bauer M. (2017) Sepsis (2017). Eine neue Definition führt zu neuen Konzepten Dtsch Arztebl 2017. 114(29–30): A-1424/B-1196/C-1170

    Google Scholar 

  • Willms A, Guesgen C, Schaaf S, Bieler D, Websky M, Schwab R (2015) Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction. Langenbecks Arch Surg 400(1):91–99

    Article  CAS  PubMed  Google Scholar 

  • Winkeltau G, Winkeltau GU, Klosterhalfen B, Niemann H, Treutner K, Schumpelick V (1992) Differenzierte chirurgische Therapie der diffusen Peritonitis. Chirurg 63:1035–1040

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Hannoversch-Münden, Akademisches Lehrkrankenhaus der Universität Göttingen, Hannoversch-Münden, Deutschland

    Christian Eckmann

  2. Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Kaufbeuren, Kaufbeuren, Deutschland

    Stefan Maier

  3. Klinik für Allgemeine Chirurgie, Viszeral-, Thorax- und Gefäßchirurgie, Universtitätsmedizin Greifswald/MDK Bayern, Fachbereich Medizinrecht, Landshut, Deutschland

    Pia Menges

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  1. Christian Eckmann
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  2. Stefan Maier
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Correspondence to Christian Eckmann .

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Editors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Kaufbeuren, Kaufbeuren, Bayern, Germany

    Stefan Maier

  2. Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Hannoversch-Muenden, Hannoversch-Muenden, Germany

    Christian Eckmann

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Eckmann, C., Maier, S., Menges, P. (2021). Peritonitis und abdominelle Sepsis. In: Maier, S., Eckmann, C. (eds) Infektionen in der Allgemein- und Viszeralchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62508-8_9

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  • DOI: https://doi.org/10.1007/978-3-662-62508-8_9

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