Ben Creagh Brown, Stijn Blot, Dirk Vogelaers, Jean-Francois Timsit, Jordi Rello, José-Artur Paiva, Philippe Montravers, Fernando Lipovetsky, Jeffrey Lipman, Despoina Koulenti, Guy Francois, George Dimopoulos, Jan De Waele, Massimo Antonelli, Koen Blot, Mieke Deschepper, Gennaro de Pascale, Cecilia Pereyra, Adam Mikstacki, Emilio Maseda, Sonia Labeau, Massimo Girardis, Christian Eckmann, Yalim Dikmen, Dylan de Lange, Kostoula Arvaniti
Journal: Intensive care medicine 2022;48(11):1593-1606
PMID: 36151335
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.
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.
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