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

Abstract

PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients 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 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe 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=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were 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.

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

“…A multicenter cohort study (2013–2017) of hospitalized adults with community-acquired sepsis (according to SEPSIS-3 definitions) undergoing source control procedures [ 251 ] showed that source control within 6 h was associated with a reduced risk of 90-day mortality. In a post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) [ 252 ], urgent, successful source control was associated with improved survival, whereas appropriateness of empiric antibiotic treatment was not, suggesting that source control is determinative of outcome for patients with sepsis of abdominal origin. Prompt source control may also be important for other infections [ 253 ].…”

Optimized Treatment of Nosocomial Peritonitis

“…When source control is delayed, complex, or protracted, the survival of the patients with nosocomial IAI significantly worsens [94]. Actually, the control of an infection source can vary widely depending on the cause and the site of the infection: it often implies an interventional approach, surgery, or a non-surgical procedure.…”

Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

“…[ 29 ] The components of the AbSeS -classification were independently associated with mortality in the entire cohort, including all patients with intra-abdominal infection in the ICU and in the subgroup of patients with secondary peritonitis. [ 7 , 30 ]…”