Tertiary Peritonitis

Occurs after secondary peritonitis, and is characterized by recurrent episodes of sepsis, and need for multiple operative interventions.

Pathogens involved include resistant enteric aerobic and facultative gram negatives, anaerobes, enteric streptococci and less pathogenic organisms become more prominent including: Enterococcus faecium, Enterobacter, Bacteroides, Coag. negative Staph., and Candida.

Antimicrobials should ideally be directed by intra-operative specimens.

Recommend Infectious Disease consult.