Factor influencing outcome of source control in the management of complicated intra-abdominal infection in Cipto Mangunkusumo University Hospital

Abstract

Background: Source control (SC) procedure aiming to control the morbidity and mortality is essential in managing complicated intra-abdominal infection (cIAI). This study aims to review factors influencing the outcome of SC in cIAI cases at Cipto Mangunkusumo Hospital. Methods: CIAI patients undergoing SC procedure in 2017 in our hospital were retrospectively reviewed. Prevalence, etiology, demography, types of procedure, and outcomes were the variables subjected to analysis. Results: There were 110 (11.7%) cIAI cases of 945 abdominal surgeries, comprised of 74 (67.3%) males and 36 (32.7%) females. Median age was 43.9 years, including 24.5% participants aged> 60 years. The most common etiology of mortality in cIAI was postoperative infection (POI) (36.4%), and the most frequently affected organ was lower gastrointestinal tract (GIT) (23.6%), especially colon which contributed to high mortality rates (34.6%). Operative mortality in participants who underwent drainage and debridement was 36% and 16.5%. Klebsiella pneumonia (36%) and Candida spp. (28.6%) infections were found in patients with poor outcome. Overall mortality was 20.9%. Conclusions: High rates of operative mortality commonly happened in emergency cases, relaparotomy, and cases treated with definitive procedure. Lower GIT cases had the highest frequency of cIAI. POI was the most common indication of SC procedure. Candida spp. and Klebsiella pneumonia infections were the most frequent organisms found with poor outcome. SC surgery was performed in all cIAIs.

Keywords

• complicated intra-abdominal infection
• postoperative infection
• source control