Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.
The wide limits of agreement between ΔPP and ΔPOP and the weak correlation between both values cast doubt regarding the ability of ΔPOP to substitute ΔPP to follow trend in preload dependence and classify respiratory cycles as responders or nonresponders using standard monitor during anesthesia for major abdominal surgery.
Introduction
Enterococcus
species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover
Enterococcus
spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with
Enterococcus
spp.
Material and methods
Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with
Enterococcus
. Primary endpoint was 30-day mortality.
Results
Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against
Enterococcus
was higher (7/18 (39%) vs 10/58 (17%),
p
= 0.05); however, the incidence of postoperative complications was similar. Presence of
Enterococcus
spp. other than
E. faecalis
alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an
Enterococcus
other than
E. faecalis
alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an
Enterococcus
other than
E. faecalis
alone that had an inadequate IAT (HR = 4.4 [1.3–15.3],
p
= 0.019) versus an adequate IAT (HR = 3.1 [1.0–10.0],
p
= 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors.
Conclusion
An IAT which does not cover
Enterococcus
is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with
Enterococcus
, especially when it is not an
E. faecalis
alone. It seems reasonable to use an IAT active against
Enterococcus
in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months.
Electronic supplementary material
The online version of this article (10.1186/s13054-019-2581-8) contains supplementary material, whi...
Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.
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