Epidemiology, Management, and Prognosis of Secondary Non-Postoperative Peritonitis: A French Prospective Observational Multicenter Study

Gauzit, R.; Péan, Y.; Barth, X.; Mistretta, Frédéric; Lalaude, Olivier

doi:10.1089/sur.2007.092

Cited by 75 publications

(75 citation statements)

References 30 publications

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“…This finding is consistent with multiple studies that have demonstrated an association between inappropriate antibiotic use and increased risk of therapeutic failure and mortality in the context of IAI [19][20][21][22]. This finding emphasizes the need to tailor empiric therapy utilizing patient specific factors in order to optimize outcomes for patients with IAI.…”

Section: Tellor Et Alsupporting

confidence: 90%

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

Tellor

Skrupky

Symons

et al. 2015

Surgical Infections

100

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"Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia." Surgical Infections. 16,6. 785-793. (2015 Background: Patients with intra-abdominal sepsis and associated bacteremia have a high mortality rate. However, outcomes studies in this population are limited, in part because of the small numbers of such patients. The objective of this study was to describe characteristics of critically ill patients with secondary blood stream infection (BSI) of intra-abdominal origin and identify predictors of mortality.Methods: This retrospective, single-center study evaluated patients admitted between January 2005 and January 2011 with bacteremia because of an intra-abdominal source. Patients were included if they met criteria for severe sepsis based on International Classification of Diseases, 9th Revision (ICD 9) codes for acute organ dysfunction, had a positive blood culture, had at least one ICD 9 code indicative of an intra-abdominal process, and had a confirmed or clinically suspected intra-abdominal infection (IAI) within 72 h of the blood culture. Chart review was performed to confirm the presence of these criteria and also the absence of any other potential source of bacteremia. Data were collected on patient demographics, BSI source, source control procedure details, microorganisms isolated, and antibiotics administered. Multivariable logistic regression analysis was performed to identify independent predictors of mortality. Results: Three hundred six patients with BSI were identified, of which 108 episodes were deemed to be of intraabdominal origin. Gram-negative organisms comprised 43% of blood isolates, followed by gram-positives (33%), anaerobes (14%), and yeast (9%). Appropriate antimicrobial therapy was administered in 71% of patients. The overall mortality rate was 27.8%. As compared with survivors, non-survivors were older, more likely to have underlying COPD or asthma, and have renal or metabolic failure (p < 0.05 for all). Among non-survivors, adequate source control was obtained less frequently (64% vs. 91%, p = 0.002) and median time to appropriate antibiotics was longer (23 h vs. 4 h, p = 0.004). Logistic regression analysis revealed inadequate source control (p = 0.002) and inappropriate antibiotics (p = 0.016) to be independently associated with mortality. Conclusions: Critically ill patients with a BSI of abdominal origin are at high risk for mortality. Failure to achieve adequate source control and administration of inappropriate antibiotics were independent predictors of mortality. Thus, these represent potential opportunities to impact outcomes in patients with complicated IAI.

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Section: Tellor Et Alsupporting

confidence: 90%

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

Tellor

Skrupky

Symons

et al. 2015

Surgical Infections

100

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“…Therefore, it seems that enterococci are associated with comorbidity, but we could not demonstrate an association with mortality. In a previous study, the presence of enterococci in peritoneal fluid cultures significantly increased the rate of morbidity but not that of mortality (6), while other authors established an association between polymicrobial infections involving enterococci and increased mortality (3,20,21).…”

Section: Discussionmentioning

confidence: 86%

“…More recent studies excluding postoperative cases have reported on the minor role of enterococci in secondary peritonitis in relatively healthy patients (20), although others report that the presence of this entity in cultures of peritoneal fluid significantly increases the rate of morbidity but not the rate of mortality (6).…”

mentioning

confidence: 99%

Multicenter Study Evaluating the Role of Enterococci in Secondary Bacterial Peritonitis

et al. 2010

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“…Electronic operating room log was browsed for all abdominal emergency surgery cases, which were further analysed from electronic patient records, and all consecutive operatively treated adult patients with diffuse secondary peritonitis due to perforation in GI tract between January 1, 2012 and December 31, 2013 were included in the study cohort. Patients with appendicitis or cholecystitis were excluded due to their better prognosis and straightforward treatment protocols [2,13,16]. Further, four patients were excluded from the study group because they were already receiving ICU care due to another disease (two patients with severe pancreatitis, one early postoperative period after lung transplantation and one postoperative period after operation for ruptured abdominal aortic aneurysm) during the time of GI perforation.…”

Section: Methodsmentioning

confidence: 99%

“…There are a number of studies and reviews that have analysed and listed prognostic factors in peritonitis [1,2,4,6,[12][13][14][15]. None of these previous studies specifically concentrate on preoperative variables.…”

Section: Introductionmentioning

confidence: 99%

Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study

Tolonen

Sallinen

Mentula

et al. 2016

Langenbecks Arch Surg

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Purpose The aim of this study was to analyse preoperative risk factors for mortality or intensive care unit admission to describe severe peritonitis. Methods This was a single academic centre retrospective study of consecutive adult patients operated for diffuse secondary peritonitis between 2012 and 2013. Patients with appendicitis or cholecystitis were excluded. Independent risk factors were identified using binary and ordinal logistic regression. Results A total of 223 patients were analysed. Overall 30-day mortality was 14.5 %. Postoperatively, 32.3 % of patients were admitted into the intensive care unit (ICU). Independent risk factors for severe peritonitis were septic shock (odds ratio (OR) 37.94, 95 % confidence interval (CI) 14.52-99.13), chronic kidney insufficiency ), severe sepsis (OR 4.80, 95 % CI 2.10-10.65) and cardiovascular disease (OR 2.58, 95 % CI 1.22-5.47). Patients lacking these factors had no mortality. ICU admission was refused in 24 (10.8 %) patients with 70.8 % mortality. In a subgroup of patients without treatment limitations (n = 190), independent risk factors for weighted outcome of ICU admission or mortality were septic shock (OR 11.89, 95 % CI 4.98-28.40), severe sepsis (OR 5.56, 95 % CI 2.39-12.89), metastatic malignant disease or lymphoma (OR 3.11,) and corticosteroid use (OR 2.98, 95 % CI 1.18-7.51). When receiving full level of care, patients with preoperative organ dysfunctions in this subgroup had 8.2 % 30-day mortality. Conclusions Preoperative organ dysfunctions, chronic kidney insufficiency and cardiovascular disease are the most important risk factors for severe peritonitis. Without these risk factors, patients had no mortality.

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Epidemiology, Management, and Prognosis of Secondary Non-Postoperative Peritonitis: A French Prospective Observational Multicenter Study

Cited by 75 publications

References 30 publications

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

Multicenter Study Evaluating the Role of Enterococci in Secondary Bacterial Peritonitis

Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study

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