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Clinical Trial
. 2021 Nov 12;76(12):3303-3309.
doi: 10.1093/jac/dkab307.

Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

Philippe Montravers  1   2   3 , Marina Esposito-Farèse  4   5 , Sigismond Lasocki  6 , Nathalie Grall  2   7   8 , Benoit Veber  9 , Philippine Eloy  10   11 , Philippe Seguin  12 , Emmanuel Weiss  2   13   14 , Herve Dupont  15   16 ; DURAPOP trial group
Collaborators, Affiliations
Clinical Trial

Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

Philippe Montravers et al. J Antimicrob Chemother. .

Abstract

Background: Therapeutic failure is a frequent issue in the management of post-operative peritonitis.

Objectives: A post hoc analysis of the prospective, multicentre DURAPOP trial analysed the risk factors for failures in post-operative peritonitis following adequate source control and empirical antibiotic therapy in critically ill patients.

Patients and methods: Overall failures assessed post-operatively between Day 8 and Day 45 were defined as a composite of death and/or surgical and/or microbiological failures. Risk factors for failures were assessed using logistic regression analyses.

Results: Among the 236 analysed patients, overall failures were reported in 141 (59.7%) patients, including 30 (12.7%) deaths, 81 (34.3%) surgical and 95 (40.2%) microbiological failures. In the multivariate analysis, the risk factors associated with overall failures were documented piperacillin/tazobactam therapy [adjusted OR (aOR) 2.10; 95% CI 1.17-3.75] and renal replacement therapy on the day of reoperation (aOR 2.96; 95% CI 1.05-8.34). The risk factors for death were age (aOR 1.08 per year; 95% CI 1.03-1.12), renal replacement therapy on reoperation (aOR 3.95; 95% CI 1.36-11.49) and diabetes (OR 6.95; 95% CI 1.34-36.03). The risk factors associated with surgical failure were documented piperacillin/tazobactam therapy (aOR 1.99; 95% CI 1.13-3.51), peritoneal cultures containing Klebsiella spp. (aOR 2.45; 95% CI 1.02-5.88) and pancreatic source of infection (aOR 2.91; 95% CI 1.21-7.01). No specific risk factors were identified for microbiological failure.

Conclusions: Our data suggest a predominant role of comorbidities, the severity of post-operative peritonitis and possibly of documented piperacillin/tazobactam treatment on the occurrence of therapeutic failures, regardless of their type.

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Figures

Figure 1.
Figure 1.
Subpopulations of the 141 patients in the DURAPOP trial classified as having overall failure, analysed by failure cause.
See this image and copyright information in PMC

References

    1. Montravers P, Blot S, Dimopoulos G. et al. Therapeutic management of peritonitis: a comprehensive guide for intensivists. Intensive Care Med 2016; 42: 1234–47. - PubMed
    1. De Pascale G, Carelli S, Vallecoccia MS. et al. Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients. J Crit Care 2019; 50: 169–76. - PubMed
    1. van de Groep K, Verhoeff TL, Verboom DM. et al. Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection. J Crit Care 2019; 52: 258–64. - PubMed
    1. Bassetti M, Righi E, Ansaldi F. et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med 2015; 41: 1601–10. - PubMed
    1. Bloos F, Thomas-Ruddel D, Ruddel H. et al. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care 2014; 18: R42. - PMC - PubMed

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