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

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

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.

© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

Address: Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Università Cattolica del Sacro Cuore, Rome, Italy.; Data Science Institute, Ghent University Hospital, Ghent, Belgium.; Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloniki, Greece.; Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.; Department of Epidemiology and Public Health, Sciensano, Belgium.; Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK.; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.; Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.; Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.; 3rd Department of Critical Care, "EVGENIDIO" Hospital, National and Kapodistrian University of Athens, Athens, Greece.; Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Medical University Hannover, Hannover, Germany.; Division of Scientific Affairs‑Research, European Society of Intensive Care Medicine, Brussels, Belgium.; Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy.; UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.; 2ND Critical Care Department, Attikon University Hospital, Athens, Greece.; Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium.; Jamieson Trauma Institute and The University of Queensland, Brisbane, Australia.; Nimes University Hospital, University of Montpellier, Nimes, France.; Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina.; Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain.; Université de Paris, INSERM, UMR-S 1152-PHERE, Paris, France.; Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France.; Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland.; Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland.; Grupo Infec ao e Sepsis, Intensive Care Department, Faculty of Medicine, Centro Hospitalar Universitario S. Joao, University of Porto, Porto, Portugal.; Intensive Care Unit from Hospital Interzonal General de Agudos "Prof Dr Luis Guemes", Buenos Aires, Argentina.; Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain.; Université Paris-Cité, IAME, INSERM 1137, 75018, Paris, France.; AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), 75018, Paris, France.; Department of General Internal Medicine and Infectious Diseases, AZ Delta, Roeselare, Belgium.; Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. [email protected].; UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia. [email protected].
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