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 MikstackiJosé-Artur Paiva, Cecilia Pereyra, Jordi Rello, Jean-Francois Timsit, Dirk Vogelaers, Care Medicine Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive, Lorella Pelagalli

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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.
Original languageItalian
Pages (from-to)1703-1717
Number of pages15
JournalIntensive Care Medicine
Issue number12
Publication statusPublished - 2019

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