Département d'Anesthésie-Réanimation, CHU Bichat-Claude-Bernard, GHU Nord, APHP, Paris, France.
Université de Paris, Paris, France.
J Antimicrob Chemother. 2021 Nov 12;76(12):3303-3309. doi: 10.1093/jac/dkab307.
Therapeutic failure is a frequent issue in the management of post-operative peritonitis.
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.
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.
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.
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.
治疗失败是术后腹膜炎管理中的常见问题。
对前瞻性、多中心 DURAPOP 试验进行事后分析，分析在充分控制感染源和经验性抗生素治疗的基础上，危重症患者术后腹膜炎治疗失败的危险因素。
术后第 8 天至第 45 天评估的总失败定义为死亡和/或手术和/或微生物学失败的综合指标。使用逻辑回归分析评估失败的危险因素。
在分析的 236 例患者中，141 例（59.7%）患者出现总失败，包括 30 例（12.7%）死亡、81 例（34.3%）手术失败和 95 例（40.2%）微生物学失败。多变量分析显示，与总失败相关的危险因素为有哌拉西林/他唑巴坦治疗史（调整后的比值比[aOR]2.10；95%可信区间[CI]1.17-3.75）和再手术当天行肾脏替代治疗（aOR 2.96；95%CI 1.05-8.34）。死亡的危险因素为年龄（每年增加 1.08；95%CI 1.03-1.12）、再手术时行肾脏替代治疗（aOR 3.95；95%CI 1.36-11.49）和糖尿病（OR 6.95；95%CI 1.34-36.03）。手术失败的危险因素为有哌拉西林/他唑巴坦治疗史（aOR 1.99；95%CI 1.13-3.51）、腹膜培养含有克雷伯菌属（aOR 2.45；95%CI 1.02-5.88）和胰腺来源的感染（aOR 2.91；95%CI 1.21-7.01）。未发现微生物学失败的特定危险因素。
无论失败类型如何，本研究数据表明，合并症、术后腹膜炎的严重程度以及可能的哌拉西林/他唑巴坦治疗史在治疗失败的发生中起主导作用。
