Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

Abstract

BackgroundAbdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.MethodsEPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.ResultsOf the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality.ConclusionsThe characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-420) contains supplementary material, which is available to authorized users.

Інтраабдомінальна Інфекція У Світлі Останніх Міжнародних Рекомендацій Та Її Роль У Розвитку Септичної Енцефалопатії

“…Отсутствие контроля источника и адекватной антибактериальной терапии является единственным модифицируемым фактором ри- Научный обзор / Scientific Review ска смертности у пациентов с внегоспитальными осложненными ИАИ, находящихся в ОИТ. Ор-ганная недостаточность ассоциирована с худшим прогнозом (1В) [42][43][44].…”

Current understanding in source control management in septic shock patients: a review

“…IAIs are the second cause of admission to the ICU in large series (16,17). The number of cases of peritonitis that required admission to an ICU due to organ failure had remained stable during time both community-acquired and nosocomial-related, however this latter group seems to be increasing in recent reports (18).…”

Management of Intra-Abdominal Infections

“…In 2014, the EPIC II study [226], including 13,796 adult patients from 1265 ICUs in 75 countries, demonstrated ICU mortality was higher in patients with abdominal infections compared to those with other infections (29.4 vs. 24.4%, P < 0.001). In patients with septic shock, early appropriate empiric antimicrobial therapy has a significant impact on the outcome, independent of the site of infection [227].…”