{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:05:58Z","timestamp":1787241958578,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,2]],"date-time":"2022-10-02T00:00:00Z","timestamp":1664668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>This comprehensive review of the recently published literature offers an overview of a very topical and complex healthcare problem: secondary peritonitis from multidrug-resistant pathogens, especially carbapenem-resistant Enterobacterales (CRE). Spontaneous secondary peritonitis and postsurgical secondary peritonitis are among the major causes of community- and healthcare- acquired sepsis, respectively. A large number of patients enter ICUs with a diagnosis of secondary peritonitis, and a high number of them reveal infection by CRE, P. aeruginosa or A. baumannii. For this reason, we conceived the idea to create a synthetic report on this topic including updated epidemiology data, a description of CRE resistance patterns, current strategies of antimicrobial treatment, and future perspectives. From this update it is clear that antimicrobial stewardship and precision medicine are becoming essential to fight the emergence of antimicrobial resistance and that even if there are new drugs effective against CRE causing secondary peritonitis, these drugs have to be used carefully especially in empirical therapy.<\/jats:p>","DOI":"10.3390\/antibiotics11101347","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T22:47:27Z","timestamp":1665182847000},"page":"1347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Literature Overview of Secondary Peritonitis Due to Carbapenem-Resistant Enterobacterales (CRE) in Intensive Care Unit (ICU) Patients"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0399-2677","authenticated-orcid":false,"given":"Sveva","family":"Di Franco","sequence":"first","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1330-5968","authenticated-orcid":false,"given":"Aniello","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio Cardarelli, Viale Antonio Cardarelli 9, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7263-0229","authenticated-orcid":false,"given":"Marco","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Fittipaldi","sequence":"additional","affiliation":[{"name":"Unit of Critical Care Hospital \u201cOspedale Pellegrini\u201d, Via Portamedina alla Pignasecca 41, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-3388","authenticated-orcid":false,"given":"Vincenzo","family":"Pota","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-7393","authenticated-orcid":false,"given":"Francesco","family":"Coppolino","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-3586","authenticated-orcid":false,"given":"Pasquale","family":"Sansone","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Caterina","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9659-0847","authenticated-orcid":false,"given":"Maria Beatrice","family":"Passavanti","sequence":"additional","affiliation":[{"name":"Department of Women, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1097\/01.CCM.0000168253.91200.83","article-title":"International Sepsis Forum Definition of Infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit","volume":"33","author":"Calandra","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12941-015-0110-4","article-title":"Spectrum adequacy of antibiotic regimens for secondary peritonitis: A retrospective analysis in intermediate and intensive care unit patients","volume":"14","author":"Steinbach","year":"2015","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1186\/s13054-019-2663-7","article-title":"The SOFA score\u2014Development, utility and challenges of accurate assessment in clinical trials","volume":"23","author":"Lambden","year":"2019","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"k1407","DOI":"10.1136\/bmj.k1407","article-title":"Secondary peritonitis: Principles of diagnosis and intervention","volume":"361","author":"Ross","year":"2018","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1086\/649554","article-title":"Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America","volume":"50","author":"Solomkin","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1089\/sur.2007.092","article-title":"Top Study Team. Epidemiology, management, and prognosis of secondary non-postoperative peritonitis: A French prospective observational multicenter study","volume":"10","author":"Gauzit","year":"2009","journal-title":"Surg. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"De Waele, J., Lipman, J., Sakr, Y., Marshall, J.C., Vanhems, P., Barrera Groba, C., Leone, M., and Vincent, J.L. (2014). EPIC II Investigators. Abdominal infections in the intensive care unit: Characteristics, treatment and determinants of outcome. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-420"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1089\/sur.2014.148","article-title":"Epidemiology and Microbiology of Secondary Peritonitis Caused by Viscus Perforation: A Single-Center Retrospective Study","volume":"16","author":"Jang","year":"2015","journal-title":"Surg. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1080\/14656566.2018.1540593","article-title":"How does one decide the best pharmacotherapeutic strategy for bacterial peritonitis?","volume":"19","author":"Schlabe","year":"2018","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_10","first-page":"E176","article-title":"Susceptibility of multidrug resistant clin-ical pathogens to a chlorhexidine formulation","volume":"56","author":"Kaiser","year":"2015","journal-title":"Prev. Med. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.4254\/wjh.v12.i12.1136","article-title":"Spontaneous bacterial peritonitis due to carbapenemase-producing Enterobacterales: Etiology and antibiotic treatment","volume":"12","author":"Fiore","year":"2020","journal-title":"World J. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1128\/CMR.00001-07","article-title":"Carbapenemases: The Versatile \u03b2-Lactamases","volume":"20","author":"Queenan","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1128\/JCM.06131-11","article-title":"Phenotypic Screening of Carbapenemases and Associated \u03b2-Lactamases in Carbapenem-Resistant Enterobacterales","volume":"50","author":"Birgy","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3390\/antibiotics3030398","article-title":"Acquired Class D \u03b2-Lactamases","volume":"3","author":"Antunes","year":"2014","journal-title":"Antibiotics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1021\/ja016736t","article-title":"High-resolution X-ray structure of an acyl-enzyme species for the class D OXA-10 -lactamase","volume":"124","author":"Maveyraud","year":"2002","journal-title":"J. Am. Chem. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The Epidemiology of Carbapenem-Resistant Enterobacterales: The Impact and Evolution of a Global Menace","volume":"215","author":"Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1586\/14787210.2016.1120669","article-title":"Basis for selecting optimum antibiotic regimens for secondary peritonitis","volume":"14","author":"Maseda","year":"2016","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1128\/MMBR.00078-15","article-title":"Klebsiella pneumoniae: Going on the Offense with Strong Defense","volume":"80","author":"Michelle","year":"2016","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1128\/JCM.39.7.2729-2731.2001","article-title":"Comparative Evaluation of Penicillin, Ampicillin, and Imipenem MICs and Susceptibility Breakpoints for Vancomycin-Susceptible and Vancomycin-Resistant Enterococcus faecalis and Enterococcus faecium","volume":"39","author":"Weinstein","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1517\/14656566.2016.1145658","article-title":"Treatment options for infections caused by carbapenem resistant Enterobacterales: Can we apply \u201cprecision medicine\u201d to antimicrobial chemotherapy?","volume":"17","author":"Perez","year":"2016","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Giurazza, R., Mazza, M.C., Andini, R., Sansone, P., Pace, M.C., and Durante-Mangoni, E. (2021). Emerging Treatment Options for Multi-Drug-Resistant Bacterial Infections. Life, 11.","DOI":"10.3390\/life11060519"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ijantimicag.2011.06.003","article-title":"Italian Intra-abdominal Infections Working Group. Intra-abdominal Infections: Model of Antibiotic Stewardship in an Era with Limited Antimicrobial Options","volume":"38","author":"Leone","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.cmi.2017.09.001","article-title":"New agents for the treatment of infections with Gram-negative bacteria: Restoring the miracle or false dawn?","volume":"23","author":"Wright","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Yusuf, E., Bax, H., Verkaik, N., and van Westreenen, M. (2021). An update on eight \u201cnew\u201d antibiotics against multidrug-resistant gramnegative bacteria. J. Clin. Med., 10.","DOI":"10.3390\/jcm10051068"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2217\/fmb.11.49","article-title":"Therapeutic options for infections with Enterobacterales producing carbapenem hydrolyzing enzymes","volume":"6","author":"Falagas","year":"2011","journal-title":"Future Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1111\/j.1469-0691.2011.03572.x","article-title":"Outbreak of KPC-3-producing, and colistin-resistant, Klebsiella pneumoniae infections in two Sicilian hospitals","volume":"17","author":"Mezzatesta","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1128\/AAC.01222-13","article-title":"Antibiotic treatment of infections due to carbapenem-resistant Enterobacterales: Systematic evaluation of the available evidence","volume":"58","author":"Falagas","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00134-015-3751-z","article-title":"Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: A multicenter randomized control trial","volume":"41","author":"Payen","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.ijantimicag.2016.02.001","article-title":"Susceptibility of contemporary isolates to fosfomycin: A systematic review of the literature","volume":"47","author":"Vardakas","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1056\/NEJMoa1801467","article-title":"Once-daily plazomicin for complicated urinary tract infections","volume":"380","author":"Wagenlehner","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1056\/NEJMc1807634","article-title":"Plazomicin for infections caused by carbapenem-resistant Enterobacterales","volume":"380","author":"McKinnell","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rodriguez-Bano, J., Guti\u00e9rrez-Guti\u00e9rrez, B., Machuca, I., and Pascual, A. (2018). Treatment of infections caused by extended-spectrum-betalactamase-,ampc-, and carbapenemase-producing Enterobacterales. Clin. Microbiol. Rev., 31.","DOI":"10.1128\/CMR.00079-17"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1007\/s10096-019-03590-3","article-title":"Eravacycline, a newly approved fluorocycline","volume":"38","author":"Lee","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S1473-3099(20)30796-9","article-title":"Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): A randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial","volume":"21","author":"Bassetti","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.2147\/DDDT.S61436","article-title":"Profile of ceftolozane\/tazobactam and its potential in the treatment of complicated intra-abdominal infections","volume":"9","author":"Skalweit","year":"2015","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e01964-16","DOI":"10.1128\/AAC.01964-16","article-title":"Ceftazidime-avibactam as salvage therapy for infections caused by carbapenem-resistant organisms","volume":"61","author":"Temkin","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e00010-19","DOI":"10.1128\/AAC.00010-19","article-title":"Aztreonam plus clavulanate, tazobactam, or avibactam for treatment of infections caused by metallo-beta-lactamase-producing gram-negative bacteria","volume":"63","author":"Emeraud","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1093\/jac\/dkaa504","article-title":"Aztreonam\/avibactam activity against clinical isolates of Enterobacterales collected in Europe, Asia and Latin America in 2019","volume":"76","author":"Sader","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s40121-018-0214-1","article-title":"Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacterales infections: The TANGO II randomized clinical trial","volume":"7","author":"Wunderink","year":"2018","journal-title":"Infect. Dis. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1093\/cid\/ciz530","article-title":"RESTORE-IMI 1: A multicenter, randomized, double-blind trial comparing efficacy and safety of imipenem\/relebactam vs. colistin plus imipenem in patients with imipenem-nonsusceptible bacterial infections","volume":"70","author":"Motsch","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6234","DOI":"10.1128\/AAC.00633-16","article-title":"Phase 2, dose-ranging study of relebactam with imipenem-cilastatin in subjects with complicated intra-abdominal infection","volume":"60","author":"Lucasti","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e251","DOI":"10.7861\/fhj.2021-0087","article-title":"Innovate to secure the future: The future of modern medicine","volume":"8","author":"Davies","year":"2021","journal-title":"Future Healthc. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.3389\/fimmu.2020.01938","article-title":"Evolutionary Approaches to Combat Antibiotic Resistance: Opportunities and Challenges for Precision Medicine","volume":"11","author":"Merker","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5492\/wjccm.v11.i1.1","article-title":"Precision medicine in sepsis and septic shock: From omics to clinical tools","volume":"11","author":"Palmada","year":"2022","journal-title":"World J. Crit. Care Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.chest.2016.11.036","article-title":"Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study","volume":"151","author":"Marik","year":"2017","journal-title":"Chest"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"458","DOI":"10.4103\/joacp.JOACP_388_19","article-title":"Should serial monitoring of procalcitonin be done routinely in critically ill patients of ICU: A systematic review and metaanalysis","volume":"36","author":"Patnaik","year":"2020","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"\u00d6nal, U., Valenzuela-S\u00e1nchez, F., Vandana, K.E., and Rello, J. (2018). Mid-Regional Pro-Adrenomedullin (MRproADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review. Healthcare, 6.","DOI":"10.3390\/healthcare6030110"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e01260-20","DOI":"10.1128\/JCM.01260-20","article-title":"Applications of machine learning to the problem of antimicrobial resistance: An emerging model for translational research","volume":"59","author":"Anahtar","year":"2021","journal-title":"J. Clin. Microbiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/10\/1347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:45:33Z","timestamp":1760143533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/10\/1347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,2]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["antibiotics11101347"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11101347","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,2]]}}}