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

Autori
Blot, Stijn ; the Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine ; 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 ; Paiva, José-Artur ; Pereyra, Cecilia ; Rello, Jordi ; Timsit, Jean-Francois ; Vogelaers, Dirk

Kolaboracija
Abdominal Sepsis Study (AbSeS) group ; Trials Group of the European Society of Intensive Care Medicine

Izvornik
Intensive Care Medicine (0342-4642) 45 (2019), 12; 1703-1717

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
Intensive care ; Intra-abdominal infection ; Mortality ; Multidrug resistance ; Peritonitis ; Sepsis

Sažetak
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.

Izvorni jezik
Engleski

POVEZANOST RADA