Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients

Gennaro De Pascale, Simone Carelli, Maria Sole Vallecoccia, Salvatore Lucio Cutuli, Temistocle Taccheri, Luca Montini, Giuseppe Bello, Teresa Spanu, Mario Tumbarello, Americo Cicchetti, Irene Urbina, Marco Oradei, Marco Marchetti, Massimo Antonelli

Research output: Contribution to journalArticle

Abstract

PURPOSE: To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs).

METHODS: Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections.

RESULTS: 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04).

CONCLUSIONS: IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.

Original languageEnglish
Pages (from-to)169-176
Number of pages8
JournalJournal of Critical Care
Volume50
DOIs
Publication statusE-pub ahead of print - Dec 12 2018

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Intraabdominal Infections
Critical Illness
Costs and Cost Analysis
Mortality
Therapeutics
Intensive Care Units
Carbapenems
Hospital Costs
Enterococcus
Methicillin-Resistant Staphylococcus aureus
Proportional Hazards Models
Cohort Studies
Retrospective Studies
Logistic Models

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Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients. / De Pascale, Gennaro; Carelli, Simone; Vallecoccia, Maria Sole; Cutuli, Salvatore Lucio; Taccheri, Temistocle; Montini, Luca; Bello, Giuseppe; Spanu, Teresa; Tumbarello, Mario; Cicchetti, Americo; Urbina, Irene; Oradei, Marco; Marchetti, Marco; Antonelli, Massimo.

In: Journal of Critical Care, Vol. 50, 12.12.2018, p. 169-176.

Research output: Contribution to journalArticle

De Pascale, G, Carelli, S, Vallecoccia, MS, Cutuli, SL, Taccheri, T, Montini, L, Bello, G, Spanu, T, Tumbarello, M, Cicchetti, A, Urbina, I, Oradei, M, Marchetti, M & Antonelli, M 2018, 'Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients', Journal of Critical Care, vol. 50, pp. 169-176. https://doi.org/10.1016/j.jcrc.2018.12.001
De Pascale, Gennaro ; Carelli, Simone ; Vallecoccia, Maria Sole ; Cutuli, Salvatore Lucio ; Taccheri, Temistocle ; Montini, Luca ; Bello, Giuseppe ; Spanu, Teresa ; Tumbarello, Mario ; Cicchetti, Americo ; Urbina, Irene ; Oradei, Marco ; Marchetti, Marco ; Antonelli, Massimo. / Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients. In: Journal of Critical Care. 2018 ; Vol. 50. pp. 169-176.
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abstract = "PURPOSE: To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs).METHODS: Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections.RESULTS: 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04).CONCLUSIONS: IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.",
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T1 - Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients

AU - De Pascale, Gennaro

AU - Carelli, Simone

AU - Vallecoccia, Maria Sole

AU - Cutuli, Salvatore Lucio

AU - Taccheri, Temistocle

AU - Montini, Luca

AU - Bello, Giuseppe

AU - Spanu, Teresa

AU - Tumbarello, Mario

AU - Cicchetti, Americo

AU - Urbina, Irene

AU - Oradei, Marco

AU - Marchetti, Marco

AU - Antonelli, Massimo

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018/12/12

Y1 - 2018/12/12

N2 - PURPOSE: To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs).METHODS: Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections.RESULTS: 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04).CONCLUSIONS: IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.

AB - PURPOSE: To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs).METHODS: Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections.RESULTS: 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04).CONCLUSIONS: IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.

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DO - 10.1016/j.jcrc.2018.12.001

M3 - Article

VL - 50

SP - 169

EP - 176

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -