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)