Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality

Abstract

The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non-postoperative/non-nosocomial) in patients admitted to intensive care units (ICUs), to investigate differences in resistance patterns linked to healthcare exposure and mortality-associated factors. A one-year prospective observational study (17 Spanish ICUs) was performed distributing cases as healthcare-associated infections (HCAI), community-acquired infections (CAI) and immunocompromised patients (ICP). Bacteria producing extended-spectrum β-lactamases (ESBL) and/or carbapenemase (CPE), high-level aminoglycoside- and/or methicillin- and/or vancomycin- resistance were considered antimicrobial resistant (AMR). Mortality-associated factors were identified by regression multivariate analysis. Of 345 patients included (18.8% HCAI, 6.1% ICP, 75.1% CAI), 51.6% presented generalized peritonitis; 32.5% were >75 years (55.4% among HCAI). Overall, 11.0% cases presented AMR (7.0% ESBL- and/or CPE), being significantly higher in HCAI (35.4%) vs. CAI (5.8%) (p<0.001) vs. ICP (0%) (p = 0.003). Overall 30-day mortality was 14.5%: 23.1% for HCAI and 11.6% for CAI (p = 0.016). Mortality (R2 = 0.262, p = 0.021) was positively associated with age >75 years (OR = 6.67, 95%CI = 2.56–17.36,p<0.001), Candida isolation (OR = 3.05, 95%CI = 1.18–7.87,p = 0.022), and SAPS II (per-point, OR = 1.08, 95%CI = 1.05–1.11, p<0.001) and negatively with biliary infections (OR = 0.06, 95%CI = 0.01–0.48,p = 0.008). In this study, the antimicrobial susceptibility pattern of bacteria isolated from patients with healthcare contact was shifted to resistance, suggesting the need for consideration of the healthcare category (not including hospital-acquired infections) for severe IAIs. 30-day mortality was positively related with age >75 years, severity and Candida isolation but not with AMR.

Can we predict death using scoring systems in patients with local peritonitis ? A retrospective study

“…Pupelis et al [19] reported a little bit higher value than ours -9.4% in patients with LP. Maseda et al [20] observed a death rate of 11.1% in critically ill patients with LP. The highest mortality rate was reported by Blot et al [7] in critically ill patients with LP -24.2%.…”

Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study

“…Likewise, Bagshaw et al concluded that age ≥80 years, regardless of the ICU admission diagnosis, was associated with higher ICU and hospital mortality compared to younger patients [2]. Previous studies suggested that advanced age is a contributing factor for death in patients with secondary peritonitis as well as in critically patients with community-onset intra-abdominal infection [7,16]. Recently, Martin-Loeches at al.…”

“…Intra-abdominal infections and in particular complicated intra-abdominal infections are difficult to treat. They differ from other severe infections in complexity of identification and diagnosis, diversity of etiology, degree of severity and need for source control [7][8][9][10][11][12][13]. Moreover, the increasing prevalence of multidrug resistant (MDR) bacteria challenges the appropriateness of empiric antibiotic therapy thereby increasing the risk for adverse outcomes [14].…”

“…Moreover, the increasing prevalence of multidrug resistant (MDR) bacteria challenges the appropriateness of empiric antibiotic therapy thereby increasing the risk for adverse outcomes [14]. Also, critical illness and age contribute to increased morbidity and mortality for patients with intra-abdominal infection [7,8]. Age older than 75 years increases the risk of death in patients with intra-abdominal infections or peritonitis related to viscous perforation [15,16].…”

Application of Antibiotics and Probiotics for Prevention of Antibiotic-Associated Disbiosis in Patients With Generalized Peritonitis and Enteral Dysfunction Supports Staff Awareness

“…Under the influence of inflammatory mediators, hypercatabolism, impaired coagulation, systemic and visceral blood flow disorders, damage of enterocytes develops rapidly, almost all functions of the digestive tract are disrupted -barrier, metabolic, immunoreactive, endocrine, etc. Intestinal insufficiency is a key moment in the development of the "vicious" circle in AP and AS, because the translocation of microorganisms and their toxins supports the general inflammatory reaction, aggravating metabolic disorders [17][18][19].…”