• Eur J Anaesthesiol · Jun 2022

    Multicenter Study Observational Study

    Time to source control and outcome in community-acquired intra-abdominal infections: The multicentre observational PERICOM study.

    • Claire Roger, Delphine Garrigue, Guillaume Bouhours, Hervé Dupont, Pierre Bouzat, Jean Bardon, Julien Pottecher, Philippe Montravers, Pierre Michelet, Sébastien Perbet, Katia Aymart, Pascal Incagnoli, Sophie Lloret, Benjamin Louart, Anatole Harrois, and ACUTE committee.
    • From the Division of Anaesthesiology, Intensive Care, Pain and Emergency Medicine, Department of Intensive Care Medicine, Nîmes University Hospital, Nîmes (CR, SL, BL), Equipe d'accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires (IMAGINE), Faculté de médecine, Univ Montpellier, Montpellier (CR, BL), Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Lille, Surgical Critical Care, F-59000 Lille (DG), Department of Anaesthesiology and Intensive Care, UNAM University, University of Angers, Angers University Hospital, 49933 Angers (GB), Department of Anesthesia and Critical Care Medicine, Centre Hospitalier Universitaire Amiens Picardie and SSPC Research Unit, Université de Picardie Jules Verne, Amiens (HD), Université Grenoble Alpes, Pôle Anesthésie-Réanimation, Centre Hospitalo-Universitaire Grenoble-Alpes, Grenoble (PB), Service d'anesthésie et des réanimations chirurgicales, Unité de réanimation chirurgicale et neuro-traumatologique, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, 94000 Créteil (JB), Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France - EA3072, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg (JP), Université de Paris, INSERM U1152, ANR-10-LABX-17, CHU Bichat-Claude Bernard, APHP, Paris (PM), Département de Médecine d'Urgence, Hôpital de la Timone - AP-HM, Aix Marseille Université, UMR 1263 C2VN, Marseille (PM), CHU Estaing, University of Auvergne, Clermont-Ferrand (SP), Service d'Accueil des Urgences, Hôpital d'Instruction des Armées Percy, Clamart (KA), Hospices Civils de Lyon, centre hospitalier Lyon Sud, service d'Anesthésie-Réanimation, Lyon (PI) and Department of Anaesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Le Kremlin Bicêtre, France (AH).
    • Eur J Anaesthesiol. 2022 Jun 1; 39 (6): 540-548.

    BackgroundOptimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment.ObjectiveTo describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes.DesignA prospective, multicentre, observational study.SettingThirteen teaching hospitals in France between April 2018 and February 2019.PatientsTwo hundred and five patients aged at least 18 years diagnosed with community-acquired IAI.Main Outcome MeasuresThe primary outcome was hospital length of stay. The secondary outcome was hospital mortality.ResultsPatients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality.ConclusionThis multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated.Study RegistrationClinicalTrials.gov on 1 April 2018, NCT03544203.Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…