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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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Proportion of microorganisma isolated from peritoneal fluid culture in community-acquired peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 42; no shock: n = 70). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.
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Figure 2: Proportion of microorganisma isolated from peritoneal fluid culture in community-acquired peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 42; no shock: n = 70). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.

Mentions: Patients who developed septic shock were significantly older than patients with no septic shock in the community-acquired peritonitis group (67 ± 17 vs. 59 ± 19 years, P = 0.03) and in the postoperative peritonitis group (68 ± 11 vs. 55 ± 18 years, P = 0.001). Bacteriologic features of peritoneal fluid culture according to type of generalized peritonitis and occurrence of septic shock are presented in Figures 2 and 3. In both types of generalized peritonitis, anaerobes were found to be significantly associated with septic shock (P = 0.02). Both types of peritonitis exhibited microbiologic differences: Enterococcus species and yeasts isolated in the culture of peritoneal fluid were significantly associated with the development of septic shock in patients with community-acquired generalized peritonitis, but not postoperative peritonitis. The RR of death was higher if yeasts were cultured from peritoneal fluid of postoperative peritonitis (RR = 4.28, 95% CI = 1.02 to 18.04, P = 0.03; Figure 4, Table 6).


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)

Proportion of microorganisma isolated from peritoneal fluid culture in community-acquired peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 42; no shock: n = 70). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Proportion of microorganisma isolated from peritoneal fluid culture in community-acquired peritonitis with (black bars) or without (white bars) septic shock. On the top of each bar: number of patients in whom the microorganism was identified with respect to total number of patients in the subgroup (shock: n = 42; no shock: n = 70). KES = Klebsiella, Enterobacter, Serratia. MRSA/MSSA = methicillin-resistant Staphylococcus aureus/Methicillin-sensitive Staphylococcus aureus.
Mentions: Patients who developed septic shock were significantly older than patients with no septic shock in the community-acquired peritonitis group (67 ± 17 vs. 59 ± 19 years, P = 0.03) and in the postoperative peritonitis group (68 ± 11 vs. 55 ± 18 years, P = 0.001). Bacteriologic features of peritoneal fluid culture according to type of generalized peritonitis and occurrence of septic shock are presented in Figures 2 and 3. In both types of generalized peritonitis, anaerobes were found to be significantly associated with septic shock (P = 0.02). Both types of peritonitis exhibited microbiologic differences: Enterococcus species and yeasts isolated in the culture of peritoneal fluid were significantly associated with the development of septic shock in patients with community-acquired generalized peritonitis, but not postoperative peritonitis. The RR of death was higher if yeasts were cultured from peritoneal fluid of postoperative peritonitis (RR = 4.28, 95% CI = 1.02 to 18.04, P = 0.03; Figure 4, Table 6).

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