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Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial
- Source :
- Journal of Antimicrobial Chemotherapy, Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), 2021, 76 (12), pp.3303-3309. ⟨10.1093/jac/dkab307⟩, Journal of Antimicrobial Chemotherapy, 2021, 76 (12), pp.3303-3309. ⟨10.1093/jac/dkab307⟩
- Publication Year :
- 2021
- Publisher :
- Oxford University Press, 2021.
-
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.
- Subjects :
- medicine.medical_treatment
[SDV]Life Sciences [q-bio]
Penicillanic Acid
Logistic regression
0302 clinical medicine
MESH: Risk Factors
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Risk Factors
Pharmacology (medical)
030212 general & internal medicine
MESH: Penicillanic Acid
Prospective Studies
Original Research
3. Good health
Anti-Bacterial Agents
Infectious Diseases
[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology
AcademicSubjects/MED00290
Piperacillin, Tazobactam Drug Combination
[SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Piperacillin/tazobactam
[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
medicine.drug
Microbiology (medical)
MESH: Piperacillin
medicine.medical_specialty
MESH: Peritonitis
Peritonitis
Tazobactam
03 medical and health sciences
Internal medicine
MESH: Anti-Bacterial Agents
Post-hoc analysis
medicine
AcademicSubjects/MED00740
Humans
Renal replacement therapy
[SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology
Pharmacology
Piperacillin
MESH: Humans
business.industry
030208 emergency & critical care medicine
medicine.disease
Comorbidity
MESH: Prospective Studies
[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
business
AcademicSubjects/MED00230
Subjects
Details
- Language :
- English
- ISSN :
- 14602091 and 03057453
- Volume :
- 76
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Journal of Antimicrobial Chemotherapy
- Accession number :
- edsair.doi.dedup.....586250ac635f82abb2702cfa869e6daf