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.
Single center retrospective study Subjective: Consecutive patients who were admitted to our ICU and received mechanical ventilation for more than 24 hours (2015.4 -2017.3) Exclusion: Patients who were younger than 20 years, were not discharged by 2017.8, were readmitted to ICU during one hospital stay, and whose APACHE II score could not be calculated Group: Group A; 74 years old or younger Group B; 75 years old or older Primary outcome: Hospital mortality Secondary outcomes: Discharge destination (home or other), physical status at hospital discharge Definition of physical status: Good; walking Poor; sitting and bed rest Analysis: t test, Mann-Whitney U test and chi-square test P values less than 0.05 were considered statistically significant.
Assesing empiric antibiotherapy in complicated communityacquired intra-abdominal infection.
RESULTS AND DISCUSSION137 patients with CA-IAI and positive intraoperative culture were identified. Gram negative bacteria (GNB) remain the major pathogens in CA-IAI (80%), gram positive bacteria are involved in 48% CA-IAI cases, anaerobes 18% and fungii 7%. Extended-spectrum betalactamase-producing Enterobacteriaceae was involved in 15% of CA-IAI, ampicilin-resistant Enterococcus spp 4%, Ps. aeruginosa 9% and Candida spp 7%.
CONCLUSIONSExtended-spectrum beta-lactamase Enterobacteriaceae increasing incidence in community-acquired intraabdominal infections represents a major problem for the future. In severe complicated intra-abdominal infection with non optimum surgical source control carbapenem should be considered for empiric antibiotherapy despite community-acquired origen.
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