IMPORTANCE OF SOURCE CONTROL IN THE SUBGROUP OF INTRA-ABDOMINAL INFECTIONS FOR SEPTIC SHOCK PATIENTS: ANALYSIS OF 390 CASES

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Uğur Önal
Deniz Akyol
Olcay Buse Kenanoğlu
Merve Mert
Dilşah Başkol
Seichan Chousein Memetali
Gamze Şanlıdağ
Cansu Bulut
Arda Kaya
Ayşe Uyan Önal
Nazlıhan Yalçın
Günel Guliyeva
Şükrü Dirik
Oğuzhan Acet
Damla Akdağ
Melike Demir
Osman Bozbıyık
Berk Göktepe
Tufan Gümüş
İlkin Çankayalı
Kubilay Demirağ
Mehmet Uyar
Hilal Sipahi
Hüseyin Aytaç Erdem
Meltem Işıkgöz Taşbakan
Bilgin Arda
Şöhret Aydemir
Sercan Ulusoy
Oğuz Reşat Sipahi

Keywords

Septic shock, Intra-abdominal infection, Source control

Abstract

Background: In this study it was aimed to evaluate the efficacy and timing with technique of the source control for the subgroup of septic shock (SS) patients with intraabdominal infections (IAI) in a tertiary-care educational hospital.


Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 in our centre were analyzed retrospectively.


Results: A total number of 390 patients were included. Overall day-30 mortality (OMM) was 42.5% on day 3 while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%) and mortality rate was significantly lower in cases that were performed source control at anytime during SS (65/123-52.8% vs 213/267-79.8%, p<0.001). In 44 of 123 cases (35.7%) source control was performed during the first 12 hours and mortality was significantly lower in this group versus others (24/44-54.5% vs 254/346-73.4%, p=0.009). On the other hand, female gender (p<0.001, odds ratio(OR)=1.714-5.054, 95%CI=1.714-5.054), diabetes mellitus (p= 0.014, OR=2.284, 95%CI=1.179-4.424), carbapenem-resistant Gram-negative etiology (p=0.011, OR=4.386, 95%CI=1.398-13.759), SOFA≥10 (p<0.001, OR=3.036, 95%CI=1.802-5.114), lactate >3 mg/dl (p<0.001, OR=2.764, 95%CI=1.562-4.891) and lack of source control (p=0.001, OR=2.796, 95%CI=1.523-5.133) were significantly associated with OMM in logistic regression analysis.


Conclusions: Source control has a vital importance in terms of mortality rates for IAI related septic shock patients. Our study underscores the need for additional research, as the present analysis indicates that early source control does not manifest as a protective factor in logistic regression.

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