Peritonitis: Spectrum of Bacteria and the Role of Antibiotics

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Abstract
Established peritoneal infection is polymicrobial with a predominance of Escherichia coli and Bacteroides fragilis. During the 1990s, a change in the spectrum of microorganisms has occasionally been observed. The role of enterococci and Candida spp. in polymicrobial infection is still uncertain. Antimicrobial treatment must be directed against both aerobes and anaerobes. Well-established combinations of an aminoglycoside plus an antianaerobic agent have been compared with monotherapy in controlled trials. While most trials have excluded patients with severe peritonitis, an efficacy similar or superior to combinations was shown with imipenem in mild as well as severe cases of peritonitis. Future studies must be aimed at reducing the failure rate of 10-20% which is still observed with peritoneal infections.

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