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Septic shock in digestive surgery: a retrospective study of 89 patients.

Author(s): Hizette P, Simoens C, Massaut J, Thill V, Smets D, da Costa PM

Affiliation(s): Department of Digestive, Thoracic and Laparoscopic Surgery, CHU Brugmann, ULB, Brussels, Belgium.

Publication date & source: 2009-11, Hepatogastroenterology., 56(96):1615-21.

BACKGROUND/AIMS: septic shock is the most severe systemic inflammatory response to infection. Septic shock is associated with organ dysfunction and with major circulatory failure. The aim of this work is to study the impact of septic shock in digestive surgery. This is a retrospective study. METHODOLOGY: Between January 2001 and March 2008, we selected patients hospitalized in the intensive care unit who underwent digestive surgery and who developed septic shock during the same hospitalization were selected: 89 patients were enrolled in this group which included 53 men and 36 women (sex ratio M/W 1.47), and the age average was 71.5 years. They were divided into two subgroups: preoperative septic shock (62/89) and postoperative (27/89). The majority of septic shock occurred in patients who developed an inflammatory disease and an organ perforation. Esophagogastric surgery generates the most postoperative septic shock. RESULTS: The overall mortality was 54%. The most frequent complications were digestive and pulmonary. The germ most frequently encountered is Escherichia coli. The majority of patients received a combination of two or three antibiotics. The empirical antibiotic therapy most frequently administered was a combination of piperacillin/ tazobactam and amikacin. DISCUSSION: The results observed in the present study are, for the most part, in agreement with those found in the literature. However, the question of the most effective antibiotic therapy remains open. CONCLUSION: In digestive surgery, septic shock is pathology with significant mortality (54%). The germ most frequently responsible is Escherichia coli. The most frequently administered empirical antibiotic therapy is a combination of amikacin and piperacillin.

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