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

Stijn Blot, Massimo Antonelli, Kostoula Arvaniti, Koen Blot, Ben Creagh-Brown, Dylan de Lange, Jan De Waele, Mieke Deschepper, Yalim Dikmen, George Dimopoulos, Christian Eckmann, Guy Francois, Massimo Girardis, Despoina Koulenti, Sonia Labeau, Jeffrey Lipman, Fernando Lipovestky, Emilio Maseda, Philippe Montravers, Adam Mikstacki, José-Artur Paiva, Cecilia Pereyra, Jordi Rello, Jean-Francois Timsit, Dirk Vogelaers

Journal: Intensive care medicine 2020;45(12):1703-1717

PMID: 31664501

Abstract

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.

Address: Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. [email protected].; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Università Cattolica del Sacro Cuore, Rome, Italy.; Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece.; Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.; Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK.; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.; Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.; Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.; Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium.; Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.; Critical Care Department, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece.; Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Medical University Hannover, Hannover, Germany.; Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium.; Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy.; Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.; 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.; Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.; Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium.; Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Australia.; Nimes University Hospital, University of Montpellier, Nimes, France.; Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina.; Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain.; Université de Paris, INSERM, UMR 1152, Paris, France.; Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France.; Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland.; Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland.; Intensive Care Department, Faculty of Medicine, Centro Hospitalar Universitario S. Joao, University of Porto, Grupo Infecçao e Sepsis, Porto, Portugal.; Intensive Care Unit from Hospital Interzonal General de Agudos "Prof Dr Luis Guemes", Buenos Aires, Argentina.; Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain.; Université de Paris, IAME, INSERM, Paris, 75018, France.; AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris, 75018, France.; General Internal Medicine, Infectious Diseases, and Psychometric Medicine, Ghent University Hospital, Ghent, Belgium.
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