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

Autores da FMUP

• José Artur Osório De Carvalho Paiva

  Autor

Participantes de fora da FMUP

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

Unidades de investigação

• Medicina

Abstract

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.

Keywords

• Intra-abdominal infection; Secondary peritonitis; Source control; Mortality; Antimicrobial therapy