Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection

被引：26

作者：

van de Groep, Kirsten ^{[1
,2
,7
]}

Verhoeff, Tessa L. ^{[3
]}

Verboom, Diana M. ^{[1
,2
,7
]}

Bos, Lieuwe D. ^{[4
]}

Schultz, Marcus J. ^{[4
,6
]}

Bonten, Marc J. M. ^{[1
,5
,7
]}

Cremer, Olaf L. ^{[2
,7
]}

de Beer, Friso M. ^{[6
]}

Bos, Lieuwe D. J. ^{[6
]}

Glas, Genie J. ^{[6
]}

Hoogendijk, Arie J. ^{[6
]}

van Hooijdonk, Roosmarijn T. M. ^{[6
]}

Horn, Janneke ^{[6
]}

Huson, Mischa A. ^{[6
]}

Juffermans, Nicole P. ^{[6
]}

van der Poll, Tom ^{[6
]}

Schouten, Laura R. A. ^{[6
]}

Scicluna, Brendon ^{[6
]}

Wiewel, Maryse A. ^{[6
]}

Witteveen, Esther ^{[6
]}

Frencken, Jos F. ^{[7
]}

Klouwenberg, M. C. Klein ^{[7
]}

Koster-Brouwer, Maria E. ^{[7
]}

Ong, David S. Y. ^{[7
]}

Varkila, Med R. J. ^{[7
]}

机构：

[1] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol, Utrecht, Netherlands

[2] Univ Utrecht, Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands

[3] Univ Utrecht, Univ Med Ctr Utrecht, Dept Anesthesiol, Utrecht, Netherlands

[4] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Intens Care, Amsterdam, Netherlands

[5] Univ Utrecht, Univ Med Ctr Utrecht, Dept Med Microbiol, Utrecht, Netherlands

[6] Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam, Netherlands

[7] Univ Utrecht, Univ Med Ctr Utrecht, Utrecht, Netherlands

来源：

JOURNAL OF CRITICAL CARE | 2019年 / 52卷

关键词：

Inn-abdominal infection; Sepsis; Therapy; Surgery; Critically ill; Epidemiology; INTENSIVE-CARE UNITS; SEPSIS; PERITONITIS; MORTALITY; MANAGEMENT;

D O I：

10.1016/j.jcrc.2019.02.029

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: To describe the characteristics and procedural outcomes of source control interventions among Intensive Care Unit (ICU) patients with severe intra-abdominal-infection (IAI). Material and methods: We identified consecutive patients with suspected IAI in whom a source control intervention had been performed in two tertiary ICUs in the Netherlands, and performed retrospective in-depth case reviews to evaluate procedure type, diagnostic yield, and adequacy of source control after 14 days. Results: A total of 785 procedures were observed among 353 patients, with initial interventions involving 266 (75%) surgical versus 87 (25%) percutaneous approaches. Surgical index procedures typically involved IAI of (presumed) gastrointestinal origin (72%), whereas percutaneous index procedures were mostly performed for infections of the biliary tract/pancreas (50%) or peritoneal cavity (33%). Overall, 178 (50%) patients required multiple interventions (median 3 (IQR 2-4)). In a subgroup of 236 patients having their first procedure upon ICU admission, effective source control was ultimately achieved for 159 (67%) subjects. Persistence of organ failure was associated with inadequacy of source control at day 14, whereas trends in inflammatory markers were non-predictive. Conclusions: Approximately half of ICU patients with IAI require more than one intervention, yet successful source control is eventually achieved in a majority of cases. (C) 2019 Elsevier Inc. All rights reserved.

引用

页码：258 / 264

页数：7

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