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Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis.

Riché FC, Dray X, Laisné MJ, Matéo J, Raskine L, Sanson-Le Pors MJ, Payen D, Valleur P, Cholley BP - Crit Care (2009)

Bottom Line: Septic shock occurrence and mortality rate were not different between community-acquired and postoperative peritonitis.Age over 65, two or more microorganisms, or anaerobes in peritoneal fluid culture were independent risk factors of shock.Unlike previous studies, we observed no difference in incidence of shock and prognosis between community-acquired and postoperative peritonitis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 75010, France. florence.riche@lrb.aphp.fr

ABSTRACT

Introduction: The risk factors associated with poor outcome in generalized peritonitis are still debated. Our aim was to analyze clinical and bacteriological factors associated with the occurrence of shock and mortality in patients with secondary generalized peritonitis.

Methods: This was a prospective observational study involving 180 consecutive patients with secondary generalized peritonitis (community-acquired and postoperative) at a single center. We recorded peri-operative occurrence of septic shock and 30-day survival rate and analyzed their associations with patients characteristics (age, gender, SAPS II, liver cirrhosis, cancer, origin of peritonitis), and microbiological/mycological data (peritoneal fluid, blood cultures).

Results: Frequency of septic shock was 41% and overall mortality rate was 19% in our cohort. Patients with septic shock had a mortality rate of 35%, versus 8% for patients without shock. Septic shock occurrence and mortality rate were not different between community-acquired and postoperative peritonitis. Age over 65, two or more microorganisms, or anaerobes in peritoneal fluid culture were independent risk factors of shock. In the subgroup of peritonitis with septic shock, biliary origin was independently associated with increased mortality. In addition, intraperitoneal yeasts and Enterococci were associated with septic shock in community-acquired peritonitis. Yeasts in the peritoneal fluid of postoperative peritonitis were also an independent risk factor of death in patients with septic shock.

Conclusions: Unlike previous studies, we observed no difference in incidence of shock and prognosis between community-acquired and postoperative peritonitis. Our findings support the deleterious role of Enterococcus species and yeasts in peritoneal fluid, reinforcing the need for prospective trials evaluating systematic treatment against these microorganisms in patients with secondary peritonitis.

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Survival according to biliary or non-biliary origin of peritonitis with septic shock.
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Figure 1: Survival according to biliary or non-biliary origin of peritonitis with septic shock.

Mentions: One hundred and eighty patients with secondary peritonitis were prospectively studied. Patients' characteristics are presented in Table 1. The origin of peritonitis is described in Table 2. Patients were separated into two groups according to the occurrence of septic shock. Seventy four patients (41%) developed perioperative septic shock (<24 hours before, during, or up to 24 hours after surgical intervention). The clinical characteristics, outcome, and bacteriologic data of patients with and without septic shock are presented in Table 3. Multivariate analysis identified three independent factors related to the occurrence of septic shock: age over 65 years, two or more microorganisms, or anaerobes in the peritoneal fluid (Table 4). Mortality at day-30 was 8% in patients who did not develop septic shock, and 35% in patients with septic shock (OR = 4.11, 95% CI = 1.78 to 9.48, P = 0.0003). Because few deaths were observed at day 30 in patients with no septic shock (9 events out of 106 patients), survival analysis could not be conducted with sufficient power in this group. Survival analysis was therefore performed only in the sub-group of patients with septic shock. Risk factors for mortality in patients with septic shock are presented in Table 5. Multivariate analysis identified two independent risk factors associated with death in the subgroup of patients with septic shock: SAPS II (adjusted OR = 1.02; 95% CI = 1.0 to 1.04, P = 0.04) and biliary origin of peritonitis (adjusted OR = 3.50; 95% CI = 1.09 to 11.70, P = 0.03). Survival curves according to biliary or non-biliary origin of peritonitis is depicted in Figure 1.


Factors associated with septic shock and mortality in generalized peritonitis: comparison between community-acquired and postoperative peritonitis.

Riché FC, Dray X, Laisné MJ, Matéo J, Raskine L, Sanson-Le Pors MJ, Payen D, Valleur P, Cholley BP - Crit Care (2009)

Survival according to biliary or non-biliary origin of peritonitis with septic shock.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2717471&req=5

Figure 1: Survival according to biliary or non-biliary origin of peritonitis with septic shock.
Mentions: One hundred and eighty patients with secondary peritonitis were prospectively studied. Patients' characteristics are presented in Table 1. The origin of peritonitis is described in Table 2. Patients were separated into two groups according to the occurrence of septic shock. Seventy four patients (41%) developed perioperative septic shock (<24 hours before, during, or up to 24 hours after surgical intervention). The clinical characteristics, outcome, and bacteriologic data of patients with and without septic shock are presented in Table 3. Multivariate analysis identified three independent factors related to the occurrence of septic shock: age over 65 years, two or more microorganisms, or anaerobes in the peritoneal fluid (Table 4). Mortality at day-30 was 8% in patients who did not develop septic shock, and 35% in patients with septic shock (OR = 4.11, 95% CI = 1.78 to 9.48, P = 0.0003). Because few deaths were observed at day 30 in patients with no septic shock (9 events out of 106 patients), survival analysis could not be conducted with sufficient power in this group. Survival analysis was therefore performed only in the sub-group of patients with septic shock. Risk factors for mortality in patients with septic shock are presented in Table 5. Multivariate analysis identified two independent risk factors associated with death in the subgroup of patients with septic shock: SAPS II (adjusted OR = 1.02; 95% CI = 1.0 to 1.04, P = 0.04) and biliary origin of peritonitis (adjusted OR = 3.50; 95% CI = 1.09 to 11.70, P = 0.03). Survival curves according to biliary or non-biliary origin of peritonitis is depicted in Figure 1.

Bottom Line: Septic shock occurrence and mortality rate were not different between community-acquired and postoperative peritonitis.Age over 65, two or more microorganisms, or anaerobes in peritoneal fluid culture were independent risk factors of shock.Unlike previous studies, we observed no difference in incidence of shock and prognosis between community-acquired and postoperative peritonitis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 75010, France. florence.riche@lrb.aphp.fr

ABSTRACT

Introduction: The risk factors associated with poor outcome in generalized peritonitis are still debated. Our aim was to analyze clinical and bacteriological factors associated with the occurrence of shock and mortality in patients with secondary generalized peritonitis.

Methods: This was a prospective observational study involving 180 consecutive patients with secondary generalized peritonitis (community-acquired and postoperative) at a single center. We recorded peri-operative occurrence of septic shock and 30-day survival rate and analyzed their associations with patients characteristics (age, gender, SAPS II, liver cirrhosis, cancer, origin of peritonitis), and microbiological/mycological data (peritoneal fluid, blood cultures).

Results: Frequency of septic shock was 41% and overall mortality rate was 19% in our cohort. Patients with septic shock had a mortality rate of 35%, versus 8% for patients without shock. Septic shock occurrence and mortality rate were not different between community-acquired and postoperative peritonitis. Age over 65, two or more microorganisms, or anaerobes in peritoneal fluid culture were independent risk factors of shock. In the subgroup of peritonitis with septic shock, biliary origin was independently associated with increased mortality. In addition, intraperitoneal yeasts and Enterococci were associated with septic shock in community-acquired peritonitis. Yeasts in the peritoneal fluid of postoperative peritonitis were also an independent risk factor of death in patients with septic shock.

Conclusions: Unlike previous studies, we observed no difference in incidence of shock and prognosis between community-acquired and postoperative peritonitis. Our findings support the deleterious role of Enterococcus species and yeasts in peritoneal fluid, reinforcing the need for prospective trials evaluating systematic treatment against these microorganisms in patients with secondary peritonitis.

Show MeSH
Related in: MedlinePlus