Department of Anesthesiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 6500047, Japan.
Emergency Care Center, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 6500047, Japan.
BMC Anesthesiol. 2024 Sep 28;24(1):344. doi: 10.1186/s12871-024-02716-1.
Lower gastrointestinal perforation (LGP) is a surgical emergency disease that can result in secondary bacterial peritonitis. Microbiological studies on LGP are rare. The present study aimed to ascertain the microbiological profile of LGP in patients admitted to the intensive care unit (ICU) at our institute after surgery. In addition, we investigated whether initial empirical therapy with vancomycin was associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support.
This single-center, retrospective, observational study was conducted at Kobe City Medical Center General Hospital, Japan. The study population included all patients diagnosed with LGP who were admitted to the ICU after emergency surgery between 2017 and 2023. The primary outcome assessed was the microbiological profile of microorganisms isolated from ascites fluid and blood of the participants. The secondary end-points were in-hospital mortality, duration of ICU stay, and duration of ventilator support. We performed univariate and multivariate regression analyses to evaluate the end-points.
During the study period, 89 patients were included in the analysis. The most commonly identified pathogen from the ascites cultures was Escherichia coli (65.2%), followed by Enterococcus spp. (51.7%). E. faecium was identified in 16 (18.0%) ascites samples. The microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on intra-abdominal infection (IAI). Therefore, the initial empirical therapy in the IAI guidelines is more appropriate for LGP. Multivariate regression analysis suggested that the combination of initial empirical therapy with vancomycin was not associated with in-hospital mortality (odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.23-3.00, p = 0.955), duration of ICU stay (coefficient=-0.92, 95% CI -3.04-1.21, p = 0.393), or duration of ventilator-support (coefficient=-9.03, 95%CI -49.69-31.63, p = 0.659).
The microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on IAI. However, the frequency of E. faecium in the present study was higher than that in previous studies. Initial empirical therapy with drugs such as meropenem in combination with vancomycin for E. faecium was not associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support, after adjusting for confounding factors.
下消化道穿孔（LGP）是一种可导致继发性细菌性腹膜炎的外科急症。针对 LGP 的微生物学研究较为少见。本研究旨在明确我院重症监护病房（ICU）术后患者 LGP 的微生物学特征。此外，我们还研究了初始经验性万古霉素治疗是否与院内死亡率、ICU 住院时间和呼吸机支持时间有关。
本单中心、回顾性、观察性研究在日本神户市医疗中心综合医院进行。研究人群包括 2017 年至 2023 年期间因急诊手术后入住 ICU 的所有 LGP 诊断患者。主要结局评估为从参与者的腹水和血液中分离出的微生物的微生物特征。次要终点是院内死亡率、ICU 住院时间和呼吸机支持时间。我们进行了单变量和多变量回归分析来评估终点。
在研究期间，共纳入 89 例患者进行分析。腹水培养最常见的病原体是大肠杆菌（65.2%），其次是肠球菌属（51.7%）。16 例（18.0%）腹水样本中分离出屎肠球菌。术后入住 ICU 的 LGP 危重症患者的微生物学特征与既往关于腹腔内感染（IAI）的研究相似。因此，IAI 指南中的初始经验性治疗更适合 LGP。多变量回归分析表明，初始经验性治疗联合万古霉素与院内死亡率（比值比[OR] = 0.96，95%置信区间 [CI] 0.23-3.00，p = 0.955）、ICU 住院时间（系数=-0.92，95%CI -3.04-1.21，p = 0.393）或呼吸机支持时间（系数=-9.03，95%CI -49.69-31.63，p = 0.659）无关。
术后入住 ICU 的 LGP 危重症患者的微生物学特征与既往关于 IAI 的研究相似。然而，本研究中屎肠球菌的频率高于既往研究。在调整混杂因素后，对于屎肠球菌，初始经验性治疗使用美罗培南联合万古霉素等药物与院内死亡率、ICU 住院时间和呼吸机支持时间无关。
