Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project



Blot, Stijn, Antonelli, Massimo, Arvaniti, Kostoula, Blot, Koen, Creagh-Brown, Ben, de Lange, Dylan, De Waele, Jan, Deschepper, Mieke, Dikmen, Yalim, Dimopoulos, George
et al (show 532 more authors) (2019) Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project. INTENSIVE CARE MEDICINE, 45 (12). pp. 1703-1717.

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Abstract

<h4>Purpose</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: Intra-abdominal infection, Peritonitis, Sepsis, Intensive care, Multidrug resistance, Mortality
Depositing User: Symplectic Admin
Date Deposited: 07 Feb 2020 11:23
Last Modified: 19 Jan 2023 00:04
DOI: 10.1007/s00134-019-05819-3
Open Access URL: https://doi.org/10.1007/s00134-019-05819-3
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3073951