Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Abstract

PurposeTo 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).MethodsWe 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.ResultsThe 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.ConclusionThis 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.Electronic supplementary materialThe online version of this article (10.1007/s00134-019-05819-3) contains supplementary material, which is available to authorized users.

Incidence, features, outcome and impact on health system of de-novo abdominal surgical diseases in patients admitted with COVID-19

“… 17 It has been suggested that late-onset abdominal sepsis accounts for 15% of all cases of abdominal sepsis in ICU. 18 We found that the incidence of abdominal complications not present at the time of admission is overall negligible in confirmed COVID-19-patients; however, in the subgroup of patients admitted to ICU, the rate is higher. A study on 141 critically-ill COVID-19 patients, found that five needed surgery for abdominal conditions (3.5%), mainly represented by bowel ischemia 19 ; when only cases with no signs/symptoms of abdominal disease at admission are evaluated, the rate might be lower.…”

Clinical Presentation and Incidence of Anaerobic Bacteria in Surgically Treated Biliary Tract Infections and Cholecystitis

“…In the light of the amount of time anaerobic cultures still take to complete, next generation sequencing—once it is made widely available—could offer empiric antibiotic guidance within hours of surgery and thus could avoid both unnecessary doses and omission. It is crucial to know one’s local resistance rates to antibiotics not only for aerobic bacteria, but also for anaerobic bacteria, because while we are still in a position of low rates of anaerobic antibiotic resistance, the number appears to be increasing in enteric bacteria annually [ 18 , 19 ]. Unfortunately, more recent data reporting on resistance rates in anaerobic bacteria are scarce [ 20 , 21 ].…”

Factors Influencing Prognosis of Patients with Intra-Abdominal Infection and Its Value in Assessing Prognosis

“…), the severity of the disease varies, and the severity of the disease often depends on the spread of in ammation [3] . Some studies have pointed out that the mortality rate of abdominal infection is 10.5% [4] , and some reports have exceeded this value [5] , even more than 50% for elderly and critical cases [6] . Timely and effectively control and treatment of the source of infection, and rational use of antimicrobial drugs are bene cial to the prognosis.…”