Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

• Type: Article in International Scientific Journal
• Date: 2022

Authors

De Pascale, G (Author) Other; Antonelli, M (Author) Other; Deschepper, M (Author) Other; Arvaniti, K (Author) Other; Blot, K (Author) Other; Brown, B (Author) Other; de Lange, D (Author) Other; De Waele, J (Author) Other; Dikmen, Y (Author) Other; Dimopoulos, G (Author) Other; Eckmann, C (Author) Other; Francois, G (Author) Other; Girardis, M (Author) Other; Koulenti, D (Author) Other; Labeau, S (Author) Other; Lipman, J (Author) Other; Lipovetsky, F (Author) Other; Maseda, E (Author) Other; Montravers, P (Author) Other; Mikstacki, A (Author) Other; Paiva, J-A (Author) FMUP; Pereyra, C (Author) Other; Rello, J (Author) Other; Timsit, JF (Author) Other; Vogelaers, D (Author) Other; Blot, S (Author) Other

Journal

Title: Intensive Care Medicine

Vol. 48

Pages: 1593-1606

ISSN: 0342-4642

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 1 Citation

Other information

Authenticus ID: P-00X-A14

DOI: 10.1007/s00134-022-06883-y

Abstract (EN): Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value <= 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 14