IMPORTANCE OF SOURCE CONTROL IN THE SUBGROUP OF INTRA-ABDOMINAL INFECTIONS FOR SEPTIC SHOCK PATIENTS: ANALYSIS OF 390 CASES
Main Article Content
Keywords
Septic shock, Intra-abdominal infection, Source control
Abstract
Background: In this study it was aimed to evaluate the efficacy and timing with technique of the source control for the subgroup of septic shock (SS) patients with intraabdominal infections (IAI) in a tertiary-care educational hospital.
Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 in our centre were analyzed retrospectively.
Results: A total number of 390 patients were included. Overall day-30 mortality (OMM) was 42.5% on day 3 while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%) and mortality rate was significantly lower in cases that were performed source control at anytime during SS (65/123-52.8% vs 213/267-79.8%, p<0.001). In 44 of 123 cases (35.7%) source control was performed during the first 12 hours and mortality was significantly lower in this group versus others (24/44-54.5% vs 254/346-73.4%, p=0.009). On the other hand, female gender (p<0.001, odds ratio(OR)=1.714-5.054, 95%CI=1.714-5.054), diabetes mellitus (p= 0.014, OR=2.284, 95%CI=1.179-4.424), carbapenem-resistant Gram-negative etiology (p=0.011, OR=4.386, 95%CI=1.398-13.759), SOFA≥10 (p<0.001, OR=3.036, 95%CI=1.802-5.114), lactate >3 mg/dl (p<0.001, OR=2.764, 95%CI=1.562-4.891) and lack of source control (p=0.001, OR=2.796, 95%CI=1.523-5.133) were significantly associated with OMM in logistic regression analysis.
Conclusions: Source control has a vital importance in terms of mortality rates for IAI related septic shock patients. Our study underscores the need for additional research, as the present analysis indicates that early source control does not manifest as a protective factor in logistic regression.
Downloads
Abstract 22
PDF Downloads 20
HTML Downloads 2
References
[2] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10
[3] Akın A, Alp E, Altındiş M, Azak E, Batırel A, Çağ Y, Durmuş G, Kepenek Kurt E, Sağıroğlu P, Türe Z, Candevir Ulu A, Ekmud Sepsis Working Group. Current Diagnosis and Treatment Approach to Sepsis. Mediterr J Infect Microb Antimicrob. 2018;7:17
[4] Howell MD, Davis AM. Management of Sepsis and Septic Shock. JAMA. 2017;317:847-8
[5] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43:304-77
[6] Oner AC, Durmaz-Drinkwater B, Grant RJ. Precarity of refugees: the case of Basmane-İzmir, Turkey. Journal of Ethnic and Migration Studies. 2020;47:4651-70
[7] Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010;11:79-109
[8] Brown DF, Wootton M, Howe RA. Antimicrobial susceptibility testing breakpoints and methods from BSAC to EUCAST. J Antimicrob Chemother. 2016;71:3-5
[9] Sipahi OR. Economics of antibiotic resistance. Expert Rev Anti Infect Ther. 2008;6:523-39
[10] Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke C, Ulusoy S. Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance. J Infect. 2007;55:41-8
[11] Önal U, Akyol D, Mert M, Başkol D, Memetali SC, Şanlıdağ G, Kenanoğlu B, Uyan-Önal A, Quliyeva G, Avşar CB, Akdağ D, Demir M, Erdem HA, Kahraman Ü, Bozbıyık O, Özgiray E, Bozkurt D, Akarca FK, Demirağ K, Çankayalı İ, Uyar M, Çilli F, Arda B, Yamazhan T, Pullukçu H, Taşbakan MI, Sipahi H, Ulusoy S, Sipahi OR. Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases. J Chemother. 2022;34:436-45
[12] Martínez ML, Ferrer R, Torrents E, Guillamat-Prats R, Gomà G, Suárez D, Álvarez-Rocha L, Pozo Laderas JC, Martín-Loeches I, Levy MM, Artigas A; Edusepsis Study Group. Impact of Source Control in Patients With Severe Sepsis and Septic Shock. Crit Care Med. 2017;45:11-9
[13] Kim H, Chung SP, Choi SH, Kang GH, Shin TG, Kim K, Park YS, Han KS, Choi HS, Suh GJ, Kim WY, Lim TH, Ko BS; Korean Shock Society (KoSS) Investigators. Impact of timing to source control in patients with septic shock: A prospective multi-center observational study. J Crit Care. 2019;53:176-82
[14] Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133-64
[15] Akinci D, Akhan O, Ozmen MN, Karabulut N, Ozkan O, Cil BE, Karcaaltincaba M. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up. Cardiovasc Intervent Radiol. 2005;28:744-50
[16] Theisen J, Bartels H, Weiss W, Berger H, Stein HJ, Siewert JR. Current concepts of percutaneous abscess drainage in postoperative retention. J Gastrointest Surg. 2005;9:280-3
[17] Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004;32:S513-26
[18] Hecker A, Reichert M, Reuß CJ, Schmoch T, Riedel JG, Schneck E, Padberg W, Weigand MA, Hecker M. Intra-abdominal sepsis: new definitions and current clinical standards. Langenbecks Arch Surg. 2019;404:257-71
[19] Baykara N, Akalın H, Arslantaş MK, Hancı V, Çağlayan Ç, Kahveci F, Demirağ K, Baydemir C, Ünal N; Sepsis Study Group. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Crit Care. 2018;22:93
[20] van de Groep K, Verhoeff TL, Verboom DM, Bos LD, Schultz MJ, Bonten MJM, Cremer OL; MARS consortium. Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection. J Crit Care. 2019;52:258-64
[21] Jung B, Molinari N, Nasri M, Hajjej Z, Chanques G, Jean-Pierre H, Panaro F, Jaber S. Procalcitonin biomarker kinetics fails to predict treatment response in perioperative abdominal infection with septic shock. Crit Care. 2013;17:R255
[22] Wang Y, Wang D, Fu J, Liu Y. [Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29:700-4
[23] Arvaniti K, Dimopoulos G, Antonelli M, Blot K, Creagh-Brown B, Deschepper M, de Lange D, De Waele J, Dikmen Y, Eckmann C, Einav S, Francois G, Fjeldsoee-Nielsen H, Girardis M, Jovanovic B, Lindner M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Makikado LDU, Maseda E, Mikstacki A, Montravers P, Paiva JA, Pereyra C, Rello J, Timsit JF, Tomescu D, Vogelaers D, Blot S; Abdominal Sepsis Study (AbSeS) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine. Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study. Int J Antimicrob Agents. 2022;60:106591
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers. Authors will grant copyright of their articles to the Institute of Hematology, Catholic University, Rome . No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.