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Prognosis in cats with septic peritonitis

Scotti KM, Koenigshof A, Sri-Jayantha LSH, Kato M, Bishop M, Barr JW, et al. Prognostic indicators in cats with septic peritonitis (2002–2015): 83 cases. J Vet Emerg Crit Care. 2019 Nov 1;29(6):647–52. 

Septic peritonitis refers to bacterial infection within the abdominal cavity. This often occurs as a result of perforation of an internal organ, such as gut, bladder, gallbladder, or uterus, but may also occur as a result of penetrating wounds, or even spontaneously. Septic peritonitis (SP) is a life-threatening issue that often requires surgery and intensive medical care to correct. The purpose of this study was to determine if physical exam and laboratory findings, time to intervention and type of intervention influenced survival in cats with septic peritonitis.

This study was designed as a multi-center retrospective observational study of cats presented to one of four tertiary care facilities over a 13-year period with a diagnosis of septic peritonitis. Patient records were reviewed for signalment, physical exam and hematologic parameters, surgical details, culture results, antimicrobial use, and other treatment and presenting factors.

One hundred thirty-five cats were recruited to the study, of which 4 were excluded due to lack of definitive diagnosis at presentation, and 48 were excluded due to euthanasia prior to surgical intervention. 83 cats were included in the final analysis. Median age was 8 years, with no breed to sex predisposition.

Seventy percent of cats survived to discharge; one was euthanized during surgery, 20 were euthanized post operatively, and 4 arrested in the post-operative period. Median time to surgery was 8 hours for survivors and 17 for non survivors, however this was not statistically significant. In 41 cases, the source of peritonitis was a GI perforation, 19 had no identified source,

There was no significant difference in rectal temperature, primary vs secondary peritonitis, or CBC parameters between survivors and non survivors. Non survivors had a higher blood glucose than survivors on presentation; no other biochemical parameter was associated with prognosis. Hyperlactatemia was not a prognostic indicator.

Eighty-two of the 83 cats received antimicrobials at admission, of which 70 had culture and sensitivity results available. 50 cats were treated with appropriate empirical antibiotics, which lead to a 4.4 times greater chance of survival. Gram positive and negative infections were present in approximately equal numbers.

The authors conclude that admission blood glucose is the only identified parameter associated with survival in cats with septic peritonitis. They also conclude that the only treatment factor associated with survival is the choice or appropriate antimicrobial therapy.

Though well designed as a multi center trial, this study suffered from a relatively small sample size and retrospective nature. The nature of the facilities used for recruitment (i.e. university teaching hospitals) may also have introduced bias compared to a population of cats presenting to primary or secondary care facilities. There is also some bias present in the number of cats surviving to discharge, as more seriously ill cats may have been euthanized before surgery and as such were excluded from analysis. (MRK)

See also:

Culp WT, Zeldis TE, Reese MS, Drobatz KJ. Primary bacterial peritonitis in dogs and cats: 24 cases (1990-2006). J Am Vet Med Assoc. 2009;234:906-913.

Bonczynski JJ, Ludwig LL, Barton LJ, et al. Comparison of peritoneal fluid and peripheral blood pH, bicarbonate, glucose, and lactate concentration as a diagnostic tool for septic peritonitis in dogs and cats. Vet Surg. 2003;32:161-166.