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- Title
Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project.
- Authors
Blot, Stijn; Antonelli, Massimo; Arvaniti, Kostoula; Blot, Koen; Creagh-Brown, Ben; de Lange, Dylan; De Waele, Jan; Deschepper, Mieke; Dikmen, Yalim; Dimopoulos, George; Eckmann, Christian; Francois, Guy; Girardis, Massimo; Koulenti, Despoina; Labeau, Sonia; Lipman, Jeffrey; Lipovestky, Fernando; Maseda, Emilio; Montravers, Philippe; Mikstacki, Adam
- Abstract
<bold>Purpose: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
INTRA-abdominal infections; INTRA-abdominal hypertension; EPIDEMIOLOGY; NOSOCOMIAL infections; DRUG resistance in microorganisms; COMMUNITY-acquired infections; CRITICALLY ill; CATASTROPHIC illness; COMPARATIVE studies; CAUSES of death; EPIDEMIOLOGICAL research; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; SEPSIS; EVALUATION research
- Publication
Intensive Care Medicine, 2019, Vol 45, Issue 12, p1703
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-019-05819-3