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

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F22%3A00083539" target="_blank" >RIV/00023001:_____/22:00083539 - isvavai.cz</a>

Výsledek na webu

<a href="https://link.springer.com/content/pdf/10.1007/s00134-022-06883-y.pdf?pdf=button" target="_blank" >https://link.springer.com/content/pdf/10.1007/s00134-022-06883-y.pdf?pdf=button</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1007/s00134-022-06883-y" target="_blank" >10.1007/s00134-022-06883-y</a>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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 &apos;emergency&apos; (&lt; 2 h), &apos;urgent&apos; (2-6 h), and &apos;delayed&apos; (&gt; 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 &lt;= 4-55.4% for a value &gt; 12, p &lt; 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 &apos;emergency&apos; source control intervention (&lt; 2 h of diagnosis), &apos;urgent&apos; source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion &apos;Urgent&apos; 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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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 &apos;emergency&apos; (&lt; 2 h), &apos;urgent&apos; (2-6 h), and &apos;delayed&apos; (&gt; 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 &lt;= 4-55.4% for a value &gt; 12, p &lt; 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 &apos;emergency&apos; source control intervention (&lt; 2 h of diagnosis), &apos;urgent&apos; source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion &apos;Urgent&apos; 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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30221 - Critical care medicine and Emergency medicine

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2022

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Intensive care medicine

ISSN

0342-4642

e-ISSN

1432-1238

Svazek periodika

48

Číslo periodika v rámci svazku

11

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

14

Strana od-do

1593-1606

Kód UT WoS článku

000857288000002

EID výsledku v databázi Scopus

2-s2.0-85140368936