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

Gennaro De Pascale, Massimo Antonelli, Mieke Deschepper (UGent) , Kostoula Arvaniti, Koen Blot, Ben Creagh Brown, Dylan de Lange, Jan De Waele (UGent) , Yalim Dikmen, George Dimopoulos, et al.
(2022) INTENSIVE CARE MEDICINE. 48(11). p.1593-1606
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Abstract
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' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 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.
Keywords
Antimicrobial therapy, Mortality, Source control, Secondary peritonitis, Intra-abdominal infection

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MLA
De Pascale, Gennaro, et al. “Poor Timing and Failure of Source Control Are Risk Factors for Mortality in Critically Ill Patients with Secondary Peritonitis.” INTENSIVE CARE MEDICINE, vol. 48, no. 11, 2022, pp. 1593–606, doi:10.1007/s00134-022-06883-y.
APA
De Pascale, G., Antonelli, M., Deschepper, M., Arvaniti, K., Blot, K., Brown, B. C., … Blot, S. (2022). Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis. INTENSIVE CARE MEDICINE, 48(11), 1593–1606. https://doi.org/10.1007/s00134-022-06883-y
Chicago author-date
De Pascale, Gennaro, Massimo Antonelli, Mieke Deschepper, Kostoula Arvaniti, Koen Blot, Ben Creagh Brown, Dylan de Lange, et al. 2022. “Poor Timing and Failure of Source Control Are Risk Factors for Mortality in Critically Ill Patients with Secondary Peritonitis.” INTENSIVE CARE MEDICINE 48 (11): 1593–1606. https://doi.org/10.1007/s00134-022-06883-y.
Chicago author-date (all authors)
De Pascale, Gennaro, Massimo Antonelli, Mieke Deschepper, Kostoula Arvaniti, Koen Blot, Ben Creagh Brown, Dylan de Lange, Jan De Waele, Yalim Dikmen, George Dimopoulos, Christian Eckmann, Guy Francois, Massimo Girardis, Despoina Koulenti, Sonia Labeau, Jeffrey Lipman, Fernando Lipovetsky, Emilio Maseda, Philippe Montravers, Adam Mikstacki, Jose-Artur Paiva, Cecilia Pereyra, Jordi Rello, Jean-Francois Timsit, Dirk Vogelaers, and Stijn Blot. 2022. “Poor Timing and Failure of Source Control Are Risk Factors for Mortality in Critically Ill Patients with Secondary Peritonitis.” INTENSIVE CARE MEDICINE 48 (11): 1593–1606. doi:10.1007/s00134-022-06883-y.
Vancouver
1.
De Pascale G, Antonelli M, Deschepper M, Arvaniti K, Blot K, Brown BC, et al. Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis. INTENSIVE CARE MEDICINE. 2022;48(11):1593–606.
IEEE
[1]
G. De Pascale et al., “Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis,” INTENSIVE CARE MEDICINE, vol. 48, no. 11, pp. 1593–1606, 2022.
@article{01GQFBRQ18F0NYH2244ZMXSFWG,
  abstract     = {{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' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 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.}},
  author       = {{De Pascale, Gennaro and  Antonelli, Massimo and Deschepper, Mieke and  Arvaniti, Kostoula and Blot, Koen and  Brown, Ben Creagh and  de Lange, Dylan and De Waele, Jan and  Dikmen, Yalim and  Dimopoulos, George and  Eckmann, Christian and  Francois, Guy and  Girardis, Massimo and  Koulenti, Despoina and  Labeau, Sonia and  Lipman, Jeffrey and  Lipovetsky, Fernando and  Maseda, Emilio and  Montravers, Philippe and  Mikstacki, Adam and  Paiva, Jose-Artur and  Pereyra, Cecilia and  Rello, Jordi and  Timsit, Jean-Francois and Vogelaers, Dirk and Blot, Stijn}},
  issn         = {{0342-4642}},
  journal      = {{INTENSIVE CARE MEDICINE}},
  keywords     = {{Antimicrobial therapy,Mortality,Source control,Secondary peritonitis,Intra-abdominal infection}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1593--1606}},
  title        = {{Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis}},
  url          = {{http://doi.org/10.1007/s00134-022-06883-y}},
  volume       = {{48}},
  year         = {{2022}},
}
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