TY - JOUR
T1 - Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project
AU - Blot, Stijn
AU - Antonelli, Massimo
AU - Arvaniti, Kostoula
AU - Blot, Koen
AU - Creagh-Brown, Ben
AU - de Lange, Dylan
AU - De Waele, Jan
AU - Deschepper, Mieke
AU - Dikmen, Yalim
AU - Dimopoulos, George
AU - Eckmann, Christian
AU - Francois, Guy
AU - Girardis, Massimo
AU - Koulenti, Despoina
AU - Labeau, Sonia
AU - Lipman, Jeffrey
AU - Lipovestky, Fernando
AU - Maseda, Emilio
AU - Montravers, Philippe
AU - Mikstacki, Adam
AU - Paiva, José Artur
AU - Pereyra, Cecilia
AU - Rello, Jordi
AU - Timsit, Jean Francois
AU - Vogelaers, Dirk
AU - Lamrous, Amin
AU - Rezende-Neto, Joao
AU - Cardenas, Yenny
AU - Vymazal, Tomas
AU - Fjeldsoee-Nielsen, Hans
AU - Kott, Matthias
AU - Kostoula, Arvaniti
AU - Javeri, Yash
AU - Einav, Sharon
AU - Makikado, Luis Daniel Umezawa
AU - Tomescu, Dana
AU - Gritsan, Alexey
AU - Jovanovic, Bojan
AU - Venkatesan, Kumaresh
AU - Mirkovic, Tomislav
AU - Creagh-Brown, Benedict
AU - Lamrous, Amin
AU - Emmerich, Monica
AU - Canale, Mariana
AU - Dietz, Lorena Silvina
AU - Ilutovich, Santiago
AU - Miñope, John Thomas Sanchez
AU - Silva, Ramona Baldomera
AU - Montenegro, Martin Alexis
AU - Morton, Benjamin
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.
AB - Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.
KW - Intensive care
KW - Intra-abdominal infection
KW - Mortality
KW - Multidrug resistance
KW - Peritonitis
KW - Sepsis
U2 - 10.1007/s00134-019-05819-3
DO - 10.1007/s00134-019-05819-3
M3 - Article
SN - 0342-4642
VL - 45
SP - 1703
EP - 1717
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 12
ER -