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

Claire Roger (1, 2) , Delphine Garrigue (3) , Guillaume Bouhours , Herve Dupont (4) , Pierre Bouzat (5) , Jean Bardon (6) , Julien Pottecher (7, 8, 9) , Philippe Montravers (10, 11) , Pierre Michelet (12, 13) , Sebastien Perbet (14) , Katia Aymart , Pascal Incagnoli (15) , Sophie Lloret (1) , Benjamin Louart (1, 2) , Anatole Harrois (16, 17)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 IMAGINE - Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts
3 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
4 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
5 ANTE-INSERM U836, équipe 5 - Neuro-imagerie fonctionnelle et métabolique
6 Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor]
7 FMTS - Fédération de Médecine Translationnelle de Strasbourg
8 HUS - Les Hôpitaux Universitaires de Strasbourg
9 Hôpital de Hautepierre [Strasbourg]
10 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
11 PHERE (UMR_S_1152 / U1152) - Physiopathologie et Epidémiologie des Maladies Respiratoires
12 TIMONE - Hôpital de la Timone [CHU - APHM]
13 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
14 Pôle de Médecine Périopératoire [CHU Clermont-Ferrand]
15 Service d'anesthésie-réanimation
16 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
17 Université Paris-Saclay

BACKGROUND Optimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment. OBJECTIVE To 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. DESIGN A prospective, multicentre, observational study. SETTING Thirteen teaching hospitals in France between April 2018 and February 2019. PATIENTS Two hundred and five patients aged at least 18 years diagnosed with community-acquired IAI. MAIN OUTCOME MEASURES The primary outcome was hospital length of stay. The secondary outcome was hospital mortality. RESULTS Patients 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. CONCLUSION This 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 REGISTRATION ClinicalTrials.gov on 1 April 2018, NCT03544203.

Domaines: Médecine humaine et pathologie

Claire Roger, Delphine Garrigue, Guillaume Bouhours, Herve Dupont, Pierre Bouzat, et al.. Time to source control and outcome in community-acquired intra-abdominal infections The multicentre observational PERICOM study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2022, 39 (6), pp.540-548. ⟨10.1097/EJA.0000000000001683⟩. ⟨hal-03696971⟩