Abstract
Secondary peritonitis arises from a perforated viscus and is usually polymicrobial. Empiric antimicrobial therapy should include agents active against aerobic Gram-negative bacilli and anaerobes, but not necessarily enterococci. There are a variety of potential treatment regimens but the choice will depend on whether community-acquired or healthcare-associated, local antimicrobial resistance patterns, and the severity of the illness. Controversy exists as to whether β-lactam/β-lactamase inhibitors can be used for infections involving extended-spectrum β-lactamase-producing bacteria as some argue in favour of this if the minimum inhibitory concentrations are low. The duration of treatment is variable but less than 5 days is probably adequate for uncomplicated cases, especially if there is adequate source control, and the patient does not require admission to a critical care unit. Up to a half of all patients undergoing an emergency laparotomy for a perforated viscus will develop a surgical site infection.
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