Guidelines
Tertiary Peritonitis

Tertiary Peritonitis

Persistent or recurrent nosocomial infection of the peritoneal cavity following an episode of apparently treated secondary peritonitis

Prompt abdominal and pelvic CT to identify source

Surgical/gastroenterology consultation for source control, (debridement, percutaneous drainage), which is the cornerstone of therapy

Blood cultures in severely ill and health care associated complicated infections; peritoneal cultures can help define microbiology

Procalcitonin (PCT) not usually useful

Duration of Therapy

  • ID consult recommended
  • Microbiology may be dynamic and alter both antibiotic options and duration
  • Oral step-down with potent therapy may be eventually possible in clinically and microbiologically stable cases

Empiric Therapy

If previously on Ceftriaxone:

AND

ALTERNATIVELY

If previously on Piperacillin/Tazobactam or Critically Ill:

AND

If Candida present from peritoneal cultures

ADD

OR, for non-albicans species (e.g. glabrata)