Importance of source control in the subgroup of intraabdominal infections for septic shock patients.


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Önal U. , Akyol D., Uyan A., Bulut C., Guliyeva G., Akdağ D., ...More

ECCMID 2018, Madrid, Spain, 21 - 24 April 2018, pp.58-59

  • Publication Type: Conference Paper / Summary Text
  • City: Madrid
  • Country: Spain
  • Page Numbers: pp.58-59

Abstract

Background: In this study it was aimed to evaluate the epidemiology of septic shock with intraabdominal infections (IAI) in terms of mortality and the efficacy of early source control (first 12 h) in a tertiary-care educational hospital. Materials/methods: Patients who had septic shock (sepsis+hypotension+adrenergic agent) with IAI and consulted by Infectious Diseases consultants between Dec 2013 and Sep 2017 in our center were recorded prospectively. The patients were evaluated following the first visit at the 72 hours, 14 days and 30 days later. Arterial lactate level of >2mg/dL criterion was added as an inclusion criterion for septic shock according to 3 rd International Sepsis and Septic Shock Consensus Statement after 28rd Feb 2016. Statistical analysis was performed via Chi square test and a p value less than 0.05 was considered significant. Results: There were a total of 67 patients (mean age 65.97 ±15.20 years and 44.8% female). Microbiological etiology was elucidated in 31 out of 67 cases (Table.1). The most common reasons for IAI was intraabdominal abscess in 16 cases (23.9%) followed by intestinal perforation in 15 cases (22.4%). Mortality was 49.2%(33/67) at the 72th h visit and day 14 and 30 mortality were 74.6% and 79.1%, respectively. Despite the fact that source control by surgical or percutaneous operation was performed in 27 out of 67 cases (40.2%), mortality was significantly lower in whom source control was performed (16/27 vs 37/40, p=0.001). In 11 of 27 cases (40.7%) source control was performed during the first 12 hours and mortality was significantly lower in this group vs others (6/11 vs 47/56, p=0,028). In 18 out of 27 cases invasive surgical operation was performed while percutaneous source control was performed in 9 cases and although mortality rates among invasive operation group was higher, the difference was not statistically significant (13/18 vs 3/9, p=0.053). In seven cases antibiotic regimen did not cover the isolated pathogens at the first visit and 30th day mortality among them was 100% Conclusions: Source control has major and vital importance in terms of mortality rates for IAI related septic shock patients especially during the first 12 hours of identification.