Using the SeptiCyte RAPID to optimize antibiotic use in occlusive acute mesenteric ischemia: a pilot study

Position du problème et objectif(s) de l’étude

Occlusive acute mesenteric ischemia (OAMI) is a life-threatening condition with high mortality. Its initial presentation may mimic septic shock, and it can be complicated by intra-abdominal infections, including bacterial translocation and secondary peritonitis. Current guidelines recommend broad-spectrum empirical antibiotic therapy despite weak supporting evidence. SeptiCyte RAPID (Immunexpress, Inc, Seattle, WA 98109 USA) based on quantitative mRNA sequencing of four genes involved in bacterial sepsis response, may help differentiate sterile inflammation from true bacterial infection. We hypothesize that SeptiCyte RAPID could guide the tailored use of empirical antibiotic therapy in OAMI.

Matériel et méthodes

We conducted a prospective, observational, single-center pilot study from July to October 2024. Two adult populations were included: urgent surgery for OAMI and scheduled major vascular surgery (control group). The control group was used to assess the natural evolution of the SeptiScore pre- and post-operatively in response to mesenteric ischemia induced by vascular clamping. All patients underwent preoperative SeptiCyte RAPID, along with microbiological sampling (peritoneal fluid, blood cultures). The study was approved by a local ethics committee and registered on ClinicalTrials.gov (NCT 06507423).

Résultats & Discussion

Fifteen patients were included: eight with OAMI and seven controls. OAMI patients had a mean age of 62.5 years, and 62.5% were male. OAMI was embolic (37.5%) or thrombotic (62.5%). Severity scores were high (mean SOFA 9 ± 4, Apache III 27 ± 11), with a 62.5% mortality rate and an average ICU stay of 11 days. The mean preoperative SeptiScore was 7.65 ± 2.57 in the OAMI group and 6.33 ± 1.01 in the control group. Postoperative intra-abdominal infections occurred in 42.9% (n = 3) of OAMI patients. A Septiscore < 7.4 yielded a negative predictive value (NPV) of 100% (CI 100–100) for ruling out bacterial infection. The pre- and post-operative SeptiScore change was 2.3 in the OAMI group versus 0.8 in the control group. The postoperative Septiscore was 9.5 in OAMI patients vs. 7.3 in controls (P = 0.06).

Conclusion

These preliminary findings suggest that SeptiCyte RAPID may be a useful predictive tool for identifying OAMI patients who may not require empirical broad-spectrum antibiotics. Additionally, the SeptiScore appears to be unaffected by ischemia per se, as demonstrated by its stable evolution in the control group. Although limited by a small sample size, this pilot study highlights the potential for a more rational approach to antibiotic use in OAMI, warranting further investigation in larger studies.

Auteurs

Emmanuel NOVY (1), Denis CESARINI (1) , Luc AMANDINE (2), Simon MAÏA (2), Guerci PHILIPPE (1) - (1)Réanimation Chirurgicale Picard, Nancy, France, (2)Département Méthodologie, Promotion Et Investigation, Umds, F-54000 Nancy, France, Nancy, France

Orateur(s)

Denis CESARINI (Nancy)