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Critically ill surgical patients remain at high risk of adverse outcomes as a result of intra-abdominal infection and its related prolonged length ICU of stay.
The aim of our study was to identify the risk factors for in-hospital mortality of ICU patients suffering from complicated peritonitis, together with those factors associated with the development of tertiary peritonitis.
Prospective, observational study at our institution from 2011 to 2013. Baseline characteristics on admission, outcomes, microbiological results and antibiotics were used in our database for analysis.
343 patients were included, 158 (46.1%) with secondary and 185 (53.9%) with tertiary peritonitis. 64.4% were male, age was 63.7 ± 14.3 years and APACHE was 19.4 ± 7.8. In-hospital mortality was 37%. We showed a higher incidence of Candida spp. (Odds Ratio(OR):1.275;95% Confidence Interval(CI):1.096-1.789;P=0.016), Enterococcus faecium (OR:1.085;95% CI:1.018-1.400;P=0.002) and Enterococcus spp. (OR:1.370;95% CI:1.139-1.989;P=0.047) in tertiary peritonitis. Higher rates in the use of cephalosporins was shown in secondary peritonitis (OR:3.51;95% CI:1.139-10.817;P=0.035). Longer ICU stay (OR:1.019;95% CI:1.004-1.034;P = 0.010), urgent surgery (OR:3.247;95% CI:1.392-7.575;P = 0.006), total parenteral nutrition (OR:3.079;95% CI:1.535-6.177;P = 0.002) and stomach-duodenum as primary infection site (OR:4.818;95% CI:1.429-16.247; P = 0.011) were factors associated with the development of tertiary peritonitis whereas suffering from localized peritonitis was protective for their development (OR:0.308;95% CI:0.152-0.624;P = 0.001). Multivariate analysis showed that predictors for in-hospital mortality were age (OR:1.028;95% CI:1.011-1.045;P = 0.001), arterial lactate (OR:1.088;95% CI:1.043-1.136; p < 0.001) and APACHE on admission (OR:1.058;95% CI:1.017-1.101;P = 0.005) and the need for Renal Replacement Therapy (OR:1.728;95% CI:1.179-2.533;P = 0.005).
Complicated peritonitis remains a cause of higher mortality in ICU, with urgent surgery, Total Parenteral Nutrition needs and primary infection site of stomach-duodenum as the main factors associated with tertiary peritonitis. Worst APACHE II, higher arterial lactate, older age and Renal Replacement Therapy needs were predictors of in-hospital mortality in those patients.