Barie Philip S, Hydo Lynn J, Eachempati Soumitra R
Department of Surgery, Division of Critical Care and Trauma, Weill Medical College of Cornell University, New York, NY 10021, USA.
Surg Infect (Larchmt). 2004 Winter;5(4):365-73. doi: 10.1089/sur.2004.5.365.
Critically ill surgical patients remain at high risk of adverse outcomes as a result of intra-abdominal infections, including prolonged length of stay, organ dysfunction, and death despite advances in critical care and innovations in management of the peritoneal cavity. We evaluated the causes and consequences of intra-abdominal infections among critically ill surgical patients in a single tertiary-care intensive care unit (ICU) over a decade.
Prospective study of 465 critically ill surgical patients with hollow viscus perforation and peritonitis or abscess from 1991-2002. Data collected were age, gender, admission APACHE III score, multiple organ dysfunction score, ICU and hospital length of stay, abscess (yes/no), site and type of perforation (colon vs. other), de novo vs. nosocomial origin, and mortality. Statistical analysis was by univariate ANOVA for coordinate data, Fisher exact test for continuous data, and logistic regression analysis.
The incidence of intra-abdominal infection was 5.75%, 73.7% of the patients developed organ dysfunction, and mortality was 22.6%. Females comprised 46.8% of the patients. De novo infection represented 71.8% of cases, whereas nosocomial infection comprised 28.2% of cases. Perforations were of the colon (including the appendix) 49.9% of the time. An abscess formed in 22.3% of patients; the remainder had peritonitis but no abscess. Patients in the cohort with peritonitis were older (p = 0.0157), sicker on admission (p = 0.0411) and developed more organ dysfunction (p = 0.0072), but had the same rate of mortality. Despite steadily increasing acuity since 1991 (r(2) = .71, p < 0.0001), the magnitude of organ dysfunction (r(2) = 0.11) and the mortality rate remained constant (r(2) = .01). By logistic regression, abscess correlated with less severe organ dysfunction (score > or = 5 [odds ratio 0.54, 95% CI 0.33-0.90] and > or =9 points [odds ratio 0.38, 95% CI 0.20-0.74]), and increasing magnitude of organ dysfunction was associated with mortality (each point [odds ratio 1.46, 95% CI 1.32-1.61]).
Although outcomes are improving, generalized peritonitis still causes high organ dysfunction-related mortality among critically ill surgical patients. Further improvements in resuscitation, surgical technique, and pharmacotherapy of severe intra-abdominal infections are needed.
尽管重症监护取得进展以及腹腔管理有所创新，但重症外科患者仍因腹腔内感染而面临不良结局的高风险，包括住院时间延长、器官功能障碍和死亡。我们评估了十年来一家三级医疗重症监护病房（ICU）中重症外科患者腹腔内感染的原因及后果。
对1991年至2002年间465例患有中空脏器穿孔、腹膜炎或脓肿的重症外科患者进行前瞻性研究。收集的数据包括年龄、性别、入院急性生理与慢性健康状况评分系统（APACHE III）评分、多器官功能障碍评分、ICU和住院时间、脓肿（是/否）、穿孔部位和类型（结肠与其他）、新发感染与医院获得性感染、以及死亡率。采用单因素方差分析处理坐标数据，Fisher精确检验处理连续性数据，并进行逻辑回归分析。
腹腔内感染的发生率为5.75%，7
