Time to source control and outcome in community-acquired intra-abdominal infections: The multicentre observational PERICOM study

Abstract

BACKGROUNDOptimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment.OBJECTIVETo describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes.DESIGNA prospective, multicentre, observational study.SETTINGThirteen teaching hospitals in France between April 2018 and February 2019.PATIENTSTwo hundred and five patients aged at least 18 years diagnosed with community-acquired IAI.MAIN OUTCOME MEASURESThe primary outcome was hospital length of stay. The secondary outcome was hospital mortality.RESULTSPatients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality.CONCLUSIONThis multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated.STUDY REGISTRATIONClinicalTrials.gov on 1 April 2018, NCT03544203.