6533b7ddfe1ef96bd1273633

RESEARCH PRODUCT

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

Gennaro De PascaleMassimo AntonelliMieke DeschepperKostoula ArvanitiKoen BlotBen Creagh BrownDylan De LangeJan De WaeleYalim DikmenGeorge DimopoulosChristian EckmannGuy FrancoisMassimo GirardisDespoina KoulentiSonia LabeauJeffrey LipmanFernando LipovetskyEmilio MasedaPhilippe MontraversAdam MikstackiJosé-artur PaivaCecilia PereyraJordi RelloJean-francois TimsitDirk VogelaersStijn BlotAmin LamrousCecilia PereyraFernando LipovestkyDespoina KoulentiJan De WaeleJoao Rezende-netoTomas VymazalHans Fjeldsoee-nielsenPhilippe MontraversMatthias KottArvaniti KostoulaYash JaveriMassimo GirardisSharon EinavDylan De LangeLuis Daniel Umezawa MakikadoAdam MikstackiJosé-artur PaivaDana TomescuAlexey GritsanBojan JovanovicKumaresh VenkatesanTomislav MirkovicEmilio MasedaYalim DikmenBenedict Creagh-brownMonica EmmerichMariana CanaleLorena Silvina DietzSantiago IlutovichJohn Thomas Sanchez MiñopeRamona Baldomera SilvaMartin Alexis MontenegroPatricio MartinPablo SaulViviana ChediackGiselle SuttonRocio CouceCarina BalasiniSusana GonzalezFlorencia Maria LascarEmiliano Jorge DescotteNatalia Soledad GumielaCarina Alejandra PinoCristian CesioEmanuel ValgolioEleonora CuntoCecilia DominguezFernando LipovestkyNydia Funes NelsonEsteban Martin AbegaoCecilia PereyraNorberto Christian PozoLuciana BianchiEnrique CorregerMaria Laura PastorinoErica Aurora MiyazakiNicolas GrubissichMariel GarciaNatalia BonettoNoelia Elizabeth QuevedoCristina Delia GomezFelipe QuetiLuis Gonzalez EstevarenaRuben FernandezIgnacio SantolayaNorberto Christian PozoSergio Hugo GrangeatJuan DogliaGraciela ZakalikCarlos PellegriniMaria Monserrat LloriaMercedes Esteban ChaconMariela FumaleMariela LeguizamonIrene Beatriz HidalgoRoberto Juli An TirantiPaola CapponiAgustin TitaLuis CardonnetLisandro BettiniAgñel RamosLuciano LovesioEdith Miriam MirandaAngelica Beatriz FarfanCarina TolosaLise SeguraAdelina BellocchioBrian AlvarezAdriana ManzurRodolfo LujanNatalia FernandezNahuel ScaroneAlan ZazuCarina GrohJason FletcherJulie SmithRaman AzadNitin ChavanMark KolLewis CampbellDespoina KoulentiTherese StarrBrigit RobertsBradley WibrowTimothy WarhurstMeher ChinthamuneediBernal Buitrago FerneyMarc SimonDaniel De BackerXavier WitteboleDavid De BelsVincent CollinKarolien DamsPhilippe JorensJan De WaeleJasperina DuboisJan GunstLionel HaentjensNicolas De SchryverThierry DugernierJoao Rezende-netoSandro RizoliPaul SantillanYi HanEwelina BiskupChangjing QuXinyu LiTao YuLu WeihuaDaniel Molano-francoJosé RojasJuan Mauricio Pardo OviedoDario PinillaYenny CardenasEdgar CelisMario AriasAnita VukovicMaja VudragMatija BelavicJosip ZunicJanja KuharicIrena Bozanic KrickaIna Filipovic-grcicBoris TomasevicMelanija ObrazBruna BodulicaMartin DohnalJan MalaskaMilan KratochvilIgor SatinskyPeter SchwarzZdenek KosLadislav BlahutJan MacaMarek ProtusEva KieslichováLouise Gramstrup NielsenBirgitte Marianne KroghFrancisco RivadeneiraFreddy MoralesJosé MoraAlexandra Saraguro OrozcoDiego Rolando MorochotutilloNelson Remache VargasEstuardo Salgado YepezBoris VillamaguaAdel AlsisiAbdelraouf FahmyHervé DupontSigismond LasockiCatherine Paugam-burtzArnaud FoucrierAlexandru NicaGeneviève BarjonJihad MallatGuillaume MarcotteMarc LeoneGary DuclosPhilippe BurtinPhilippe MontraversEnora AtchadeYazine MahjoubBenoît MissetJean-françois TimsitClaire DupuisBenoît VeberMatthieu DebarreOliver CollangeJulien PottecherStephane HecketsweilerMélanie FromentinAntoine TesnièreChristian KochMichael SanderMatthias KottGunnar ElkeHermann WriggePhilipp SimonAnthoula ChalkiadakiCharalampos TzanidakisIoannis PneumatikosEleni SertaridouZafiria MastoraIoannis PantazopoulosMetaxia PapanikolaouTheonymfi PapavasilopoulouJohn FlorosGeorge DimopoulosChryssa DiakakiMichael RallisAlexandra ParidouAlexandros KalogeromitrosVasiliki RomanouCharikleia NikolaouKaterina KounougeriEvdoxia TsigouVasiliki PsallidaNiki KarampelaKonstantinos MandragosEftychia KontoudakiAlexandra PentheroudakiChristos Farazi-chongoukiAgathi KarakostaIsaac ChourisVasiliki RaduPolychronis MalliotakisSofia KokkiniEliana CharalambousAikaterini KyritsiVasilios KoulourasGeorgios PapathanakosEva NagkyClairi LampiriFotios TsimpoukasIoannis SarakatsanosPanagiotis GeorgakopoulosIfigeneia RavaniAthanasios PrekatesKonstantinos SakellaridisChristos ChristopoulosEfstratia VrettouKonstantinos StokkosAnastasia PentariKostoula ArvanitiKyriaki MarmanidouChristina KydonaGeorgios TsoumaropoulosMilitisa BitzaniPaschalina KontouAntonios VoudourisElli-nikki FlioniElli AntypaEleftheria ChasouSouzana AnisoglouEirini PapageorgiouTheoniki ParaforouAgoritsa TsiokaAntigoni KarathanouAristeidis VakalosBhagyesh ShahChirag ThakkarNikhilesh JainMohan GurjarArvind BaroniaPrachee SatheShilpa KulkarniCherish PaulJohn PaulMansoor MasjediReza NikandishFarid ZandGolnar SabetianAta MahmoodpoorSeyed Mohammadreza HashemianMiklosh BalaRomeo FloccoSergio TorrenteVincenzo PotaSavino SpadaroCarlo VoltaMassimo GirardisGiulia SerafiniSabrina BorasoIvo TiberioAndrea CortegianiGiovanni MisseriMaria BarbagalloDavide NicolottiFrancesco ForforiFrancesco CorradiMassimo AntonelliGennaro De PascaleLorella PelagalliLuca BrazziFerdinando Giorgio VittoneAlessandro RussoDavide SimionAntonella CotoiaGilda Cinnella Patrick ToppinRoxanne Johnson-jacksonYoshiro HayashiRyohei YamamotoHideto YasudaYuki KishiharaJunji ShiotsukaLuis Alejandro Sanchez-hurtadoBrigitte Tejeda-huezoLuis GorordoSilvio A ÑAmendys-silvaFrancisco J Garcia-guillenManuel MartinezErick Romero-mejaEver Colorado-dominguezHuub Van Den OeverKarel Martijn KalffWytze VermeijdenAlexander Daniel CornetOliver BeckNedim CimicTom DormansLaura BormansJan BakkerDitty Van DuijnGerrit BosmanPiet VosDylan De LangeJozef KeseciogluLenneke HaasAkram HeneinAriel M MirandaLuis Daniel Umezawa MakikadoGonzalo Ernesto Gianella MalcaAbel Arroyo-sanchezAgnieszka Misiewska-kaczurFrisch AkinyiMiroslaw CzuczwarKarolina LuczakWiktor SulkowskiBarbara TamowiczAdam MikstackiBeata SwitBronisław BaranowskiPiotr SmuszkiewiczIwona TrojanowskaStanislaw RzymskiMariusz SawinskiMarta TrosiakMalgorzata Mikaszewska-sokolewiczRicardo AlvesDina LealAndriy KrystopchukPedro Muguel Hilario MendoncaRui Antunes PereiraMaria Raquel Lopes Marques De CarvalhoCarlos CandeiasElena MolinosAmélia FerreiraGuiomar CastroJosé-artur PaivaJosé-manuel PereiraLurdes SantosAlcina FerreiraDulce PascoalinhoRosa RibeiroGuilherme DomingosPedro GomesDavid NoraRui Pedro CostaAnabela SantosAhmed Subhy AlsheikhlyDana TomescuMihai PopescuIoana GrigorasEmilia PatrascanuIgor ZabolotskikhTatiana MusaevaAlexey GritsanDenis GaigolnikVladimir KulabukhovVladislav BelskiyNadezhda ZubarevaMaxim TribulevAhmed AbdelsalamAyman AldarsaniMuhammad Al-khalidGhaleb AlmekhlafiYasser MandourahBojan JovanovicKrstina DoklesticJelena VelickovicDejan VelickovicRadmilo JankovicAnita VukovicSvetlana Skoric-jokicDragana RadovanovicGuy RichardsAhmad AlliDel Carmen Cordoba NielfaRafael Sánchez IniestaAdela Benítez-cano MartínezCarlos Garcia BernedoSantiago Alberto Picos GilXavier NuvialsJordi RelloJoseba Gonzalez GarciaJose Manuel Garcia PeñaRoberto JimenezLuis HerreraLaura Galarza BarrachinaIgnacio Catalan MonzonFrancisco Javier RedondoRuben VillazalaDiego Fernando Matallana ZapataIsabel Maria Villa LopezGabriel Moreno-gonzalezJuan Carlos Lopez-delgadoJorge Solera MarinPurificacion Sanchez-zamoraMontserrat Vallverdú VidalJesús Flores GonzálezIrene SalinasCecilia HermosaEmilio MasedaFernando Martinez-sagastiSara Domingo-marínJohanna Abril VictorinoRaquel Garcia-alvarezPablo López-arcas CallejaMaria Victoria De La Torre-pradosPablo Vidal-cortesLorena Del Río-carbajoJavier IzuraVictoria MinguezJosep Trenado AlvarezAnna Parera ProusDaniel PazFerran Roche-campoGerardo AguilarJavier BeldaJesus Rico-feijooCesat AldecoaBegoña Zalba-etayoAlexander DullenkopfKonlawij TrongtrakulAnusang ChtsomkasemTürkay AkbaşMustafa Necmettin UnalAyca GumusAtilla RamazanogluDilek MemisInal MehmetYalim DikmenSeval UrkmezAsu OzgultekinOktay DemirkiranNesrin Ahu AslanDeniz KizilaslanFerda KahveciNurdan ÜNlüZeynep OzkanCallum KayeJan JansenOrla O’neillChristopher NuttRajeev JhaNicolas HookerIrina GrecuChristina PetridouMurali ShyamsundarLia McnameeJohn TrinderSamantha HaganCatriona KellyJonathon SilversidesCasiano Barrera GrobaOwen BoydKaushik BhowmickSally HumphreysCharlotte SummersPetra PolgarovaMichael MargarsonJustin DickensSuzanne PearsonElaine ChineryNoel HemmingsSinead O’kanePauline AustinStephen ColeCatherine PlowrightRoberta BoxChristopher WrightLorna YoungBen Creagh-brownLaura MontagueRobert ParkerBen MortonMarlies OstermannJulia BilinskaBernd Oliver RoseRosie Reece-anthonyChristine RyanMark HamiltonPhilip HopkinsJulia WendonGiovanni BresciaNazia IjazJames WoodMichelle GeorgePiroska Toth-tarsolyBryan YatesMaureen ArmstrongCarmen ScottChristine BoydTamas SzakmanyDavid ReesPaul PulakMandy CoggonBhaskar SahaLinda KentBethan GibsonJulie CamsooksaiHenrik ReschreiterPat MorganSivatharshini SangaralinghamAlastair LowePetr VondrasSunil JamadarkhanaCarina CruzRakesh BhandaryPeter HerseyJulie FurnevalRichard InnesPatricia DobleBen AttwoodPenny ParsonsValerie PageXiaobei ZhaoIrina GrecuJulian DaltonMohammed HegazyYasser AwadDouglas NaylorAmanda NaylorSarah LeeSidney BrevardNoelle Davis

subject

AdultSecondary peritonitiCritical IllnessPeritonitisCritical Care and Intensive Care MedicineAnti-Bacterial AgentsAntimicrobial therapyIntensive Care UnitsSecondary peritonitisIntra-abdominal infectionAnti-Infective AgentsRisk FactorsSource controlSepsisMedicine and Health SciencesHumansIntraabdominal InfectionsMortalityRetrospective StudiesAntimicrobial therapy; Intra-abdominal infection; Mortality; Secondary peritonitis; Source control

description

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' ( 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT03270345.

yearjournalcountryeditionlanguage
2022-09-23Intensive Care Medicine
https://doi.org/10.1007/s00134-022-06883-y