Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Abstract

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4–98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus

“…Several non-albicans Candida species have been isolated during IAIs, but most have never been experimentally tested as causative agents (8,33). Using the polymicrobial IAI model, five NAC species that vary in ability to undergo morphogenesis were tested for virulence.…”

“…Surprisingly, we have demonstrated that C. albicans morphogenesis is not required to induce synergistic lethality during IAIs with S. aureus (23). Recognizing that NAC species vary in morphology and ability to undergo morphogenesis (29,30), reside within the gastrointestinal tract (31,32), and have been shown to cause IAIs (8,33), it is important to extend the pathogenesis studies to NAC species and further investigate the role of pathways that regulate morphogenesis and virulence during IAIs.…”

In vitro activity of ceftolozane/tazobactam against clinical isolates of Pseudomonas aeruginosa and Enterobacteriaceae recovered in Spanish medical centres: Results of the CENIT study

“…Gram-negative bacteria are responsible for the majority of healthcare-associated infections, including urinary tract infections [1], intra-abdominal infections [2] and pneumonia [3], and are an important cause of nosocomial bloodstream infections (BSIs) [4]. Infections caused by Gram-negative bacteria have features that are of particular concern; in particular, Gram-negative bacteria are highly adaptive and often possess multiple mechanisms of antibiotic resistance, especially in the presence of antibiotic selection pressure [5].…”

2013 WSES guidelines for management of intra-abdominal infections

“…In past decades, an increased prevalence of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus , vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa , extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species, multidrug-resistant Acinetobacter species, and Candida species has been observed, particularly in cases of intra-abdominal infection [242-244]. …”