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

Blot,; aEmail Author, S.; Antonelli, M. b.; Arvaniti, C; Blot, K. d.; Creagh-Brown, K. a.; B. e., F; Lange, De; D. g.,; Waele, De; Deschepper, J. h.; Dikmen, M. i.; Dimopoulos, Y. j.; Eckmann, G. k.; Francois, C. l.; Girardis, G. m.; Koulenti, M. n.; D. o., P; Labeau, S. a.; Lipman, Q; J. r., S; Lipovestky, F. t.; Maseda, E. u.; Montravers, P. v.; Mikstacki, W; A. x., Y; Paiva,; J. -A. z.,; Pereyra,; Aa, C.; Rello,; Ab, J.; Timsit,; J. -F., Ac; Vogelaers, Ad; Ae, D.; Lamrous, A.; Rezende-Neto, J.; Cardenas, Y.; Vymazal, T.; Fjeldsoee-Nielsen, H.; Kott, M.; Kostoula, A.; Javeri, Y.; Einav, S.; Makikado, L. D. U.; Tomescu, D.; Gritsan, A.; Jovanovic, B.; Venkatesan, K.; Mirkovic, T.; Creagh-Brown, B.; Lamrous, A.; Emmerich, M.; Canale, M.; Dietz, L. S.; Ilutovich, S.; Miñope, J. T. S.; Silva, R. B.; Montenegro, M. A.; Martin, P.; Saul, P.; Chediack, V.; Sutton, G.; Couce, R.; Balasini, C.; Gonzalez, S.; Lascar, F. M.; Descotte, E. J.; Gumiela, N. S.; Pino, C. A.; Cesio, C.; Valgolio, E.; Cunto, E.; Dominguez, C.; Nelson, N. F.; Abegao, E. M.; Pozo, N. C.; Bianchi, L.; Correger, E.; Pastorino, M. L.; Miyazaki, E. A.; Pozo, N. C.; Grubissich, N.; Garcia, M.; Bonetto, N.; Quevedo, N. E.; Gomez, C. D.; Queti, F.; Estevarena, L. G.; Fernandez, R.; Santolaya, I.; Pozo, N. C.; Grangeat, S. H.; Doglia, J.; Zakalik, G.; Pellegrini, C.; Lloria, M. M.; Chacon, M. E.; Fumale, M.; Leguizamon, M.; Hidalgo, I. B.; Tiranti, R. J.; Capponi, P.; Tita, A.; Cardonnet, L.; Bettini, L.; Ramos, A.; Lovesio, L.; Miranda, E. M.; Farfan, A. B.; Tolosa, C.; Segura, L.; Bellocchio, A.; Alvarez, B.; Manzur, A.; Lujan, R.; Fernandez, N.; Scarone, N.; Zazu, A.; Groh, C.; Fletcher, J.; Smith, J.; Azad, R.; Chavan, N.; Wong, H.; Kol, M.; Campbell, L.; Starr, T.; Roberts, B.; Wibrow, B.; Warhurst, T.; Chinthamuneedi, M.; Ferney, B. B.; Simon, M.; Backer, De; Wittebole, D.; Bels, De; Collin, D.; Dams, V.; Jorens, K.; Dubois, P.; Gunst, J.; Haentjens, J.; Schryver, De; Dugernier, N.; Rezende-Neto, T.; Rizoli, J.; Santillan, S.; Han, P.; Biskup, Y.; Qu, E.; Li, C.; Yu, X.; Weihua, T.; Molano-Franco, L.; Rojas, D.; Oviedo, J.; Pinilla, J. M. P.; Cardenas, D.; Celis, Y.; Arias, E.; Vukovic, M.; Vudrag, A.; Belavic, M.; Zunic, M.; Kuharic, J.; Kricka, J.; Filipovic-Grcic, I. B.; Tomasevic, I.; Obraz, B.; Bodulica, M.; Dohnal, B.; Malaska, M.; Kratochvil, J.; Satinsky, M.; Schwarz, I.; Kos, P.; Blahut, Z.; Maca, L.; Protus, J.; Kieslichová, M.; Nielsen, E.; Krogh, L. G.; Rivadeneira, B. M.; Morales, F.; Mora, F.; Orozco, J.; Morochotutillo, A. S.; Vargas, D. R.; Yepez, N. R.; Villamagua, E. S.; Alsisi, B.; Fahmy, A.; Dupont, A.; Lasocki, H.; Paugam-Burtz, S.; Foucrier, C.; Nica, A.; Barjon, A.; Mallat, G.; Marcotte, J.; Leone, G.; Duclos, M.; Burtin, G.; Atchade, P.; Mahjoub, E.; Misset, Y.; Timsit, B.; J. -F.,; Dupuis, C.; Veber, B.; Debarre, M.; Collange, O.; Pottecher, J.; Hecketsweiler, S.; Fromentin, M.; Tesnière, A.; Koch, C.; Sander, M.; Kott, M.; Elke, G.; Wrigge, H.; Simon, P.; Chalkiadaki, A.; Tzanidakis, C.; Pneumatikos, I.; Sertaridou, E.; Mastora, Z.; Pantazopoulos, I.; Papanikolaou, M.; Papavasilopoulou, T.; Floros, J.; Kolonia, V.; Diakaki, C.; Rallis, M.; Paridou, A.; Kalogeromitros, A.; Romanou, V.; Nikolaou, C.; Kounougeri, K.; Tsigou, E.; Psallida, V.; Karampela, N.; Mandragos, K.; Kontoudaki, E.; Pentheroudaki, A.; Farazi-Chongouki, C.; Karakosta, A.; Chouris, I.; Radu, V.; Malliotakis, P.; Kokkini, S.; Charalambous, E.; Kyritsi, A.; Koulouras, V.; Papathanakos, G.; Nagky, E.; Lampiri, C.; Tsimpoukas, F.; Sarakatsanos, I.; Georgakopoulos, P.; Ravani, I.; Prekates, A.; Sakellaridis, K.; Christopoulos, C.; Vrettou, E.; Stokkos, K.; Pentari, A.; Marmanidou, K.; Kydona, C.; Tsoumaropoulos, G.; Bitzani, M.; Kontou, P.; Voudouris, A.; Flioni, Elli-Nikki; Antypa, E.; Chasou, E.; Anisoglou, S.; Papageorgiou, E.; Paraforou, T.; Tsioka, A.; Karathanou, A.; Vakalos, A.; Shah, B.; Thakkar, C.; Jain, N.; Gurjar, M.; Baronia, A.; Sathe, P.; Kulkarni, S.; Paul, C.; Paul, J.; Masjedi, M.; Nikandish, R.; Zand, F.; Sabetian, G.; Mahmoodpoor, A.; Hashemian, S. M.; Bala, M.; Flocco, R.; Torrente, S.; Pota, V.; Spadaro, S.; Volta, C.; Serafini, G.; Boraso, S.; Tiberio, I.; Cortegiani, A.; Misseri, G.; Barbagallo, M.; Nicolotti, D.; Forfori, F.; Corradi, F.; Pascale, De; Pelagalli, G.; Brazzi, L.; Vittone, L.; Russo, F. G.; Simion, A.; Cotoia, D.; Cinnella, A.; Toppin, G.; Johnson-Jackson, P.; Hayashi, R.; Yamamoto, Y.; Yasuda, R.; Kishihara, H.; Shiotsuka, Y.; Sanchez-Hurtado, J.; Tejeda-Huezo, L. A.; Gorordo, B.; Ñamendys-Silva, L.; Garcia-Guillen, S. A.; Martinez, F. J.; Romero-Meja, M.; Colorado-Dominguez, E.; van den Oever,; Kalff, H.; Vermeijden, K. M.; Cornet, W.; Beck, A. D.; Cimic, O.; Dormans, N.; Bormans, T.; Bakker, L.; Duijn, Van; Bosman, D.; Vos, G.; Haas, P.; Henein, L.; Miranda, A.; Makikado, A. M.; Malca, L. D. U.; Arroyo-Sanchez, G. E. G.; Misiewska-Kaczur, A.; Akinyi, A.; Czuczwar, F.; Luczak, M.; Sulkowski, K.; Tamowicz, W.; Swit, B.; Baranowski, B.; Smuszkiewicz, B.; Trojanowska, P.; Rzymski, I.; Sawinski, S.; Trosiak, M.; Mikaszewska-Sokolewicz, M.; Alves, M.; Leal, R.; Krystopchuk, D.; Mendonca, A.; Pereira, P. M. H.; R. A.,; Carvalho, De; Candeias, M. R. L. M.; Molinos, C.; Ferreira, E.; Castro, A.; Pereira, G.; J. -M.,; Santos, L.; Ferreira, A.; Pascoalinho, D.; Ribeiro, R.; Domingos, G.; Gomes, P.; Nora, D.; Costa, R. P.; Santos, A.; Alsheikhly, A. S.; Tomescu, D.; Popescu, M.; Grigoras, I.; Patrascanu, E.; Zabolotskikh, I.; Musaeva, T.; Gritsan, A.; Gaigolnik, D.; Kulabukhov, V.; Belskiy, V.; Zubareva, N.; Tribulev, M.; Abdelsalam, A.; Aldarsani, A.; Al-Khalid, M.; Almekhlafi, G.; Mandourah, Y.; Jovanovic, B.; Doklestic, K.; Velickovic, J.; Velickovic, D.; Jankovic, R.; Vukovic, A.; Skoric-Jokic, S.; Radovanovic, D.; Richards, G.; Alli, A.; del Carmen Cordoba Nielfa,; Iniesta, M.; Martínez, R. S.; A. B. -C.,; Bernedo, C. G.; Gil, S. A. P.; Nuvials, X.; Garcia, J. G.; Peña, J. M. G.; Jimenez, R.; Herrera, L.; Barrachina, L. G.; Monzon, I. C.; Redondo, F. J.; Villazala, R.; Zapata, D. F. M.; Lopez, I. M. V.; Moreno-Gonzalez, G.; Lopez-Delgado, J. C.; Marin, J. S.; Sanchez-Zamora, P.; Vidal, M. V.; González, J. F.; Salinas, I.; Hermosa, C.; Martinez-Sagasti, F.; Domingo-Marín, S.; Victorino, J. A.; Garcia-Alvarez, R.; Calleja,; P. L. -A.,; de la Torre-Prados,; M. -V.,; Vidal-Cortes, P.; Río-Carbajo, Del; Izura, L.; Minguez, J.; Alvarez, V.; Prous, J. T.; Paz, A. P.; Roche-Campo, D.; Aguilar, F.; Belda, G.; Rico-Feijoo, J.; Aldecoa, J.; Zalba-Etayo, C.; Lang, B.; Dullenkopf, M.; Trongtrakul, A.; Chtsomkasem, K.; Akbas, A.; Unal, T.; Ozcelik, M. N.; Gumus, M.; Ramazanoglu, A.; Memis, A.; Mehmet, D.; Urkmez, I.; Ozgultekin, S.; Demirkiran, A.; Aslan, O.; Kizilaslan, N. A.; Kahveci, D.; Ünlü, F.; Ozkan, N.; Kaye, Z.; Jansen, C.; O’Neill, J.; Nutt, O.; Jha, C.; Hooker, R.; Grecu, N.; Petridou, I.; Shyamsundar, C.; Mcnamee, M.; Trinder, L.; Hagan, J.; Kelly, S.; Silversides, C.; Groba, J.; Boyd, C. B.; Bhowmick, O.; Humphreys, K.; Summers, S.; Polgarova, C.; Margarson, P.; Dickens, M.; Pearson, J.; Chinery, S.; Hemmings, E.; O’Kane, N.; Austin, S.; Cole, P.; Plowright, S.; Box, C.; Wright, R.; Young, C.; Montague, L.; Parker, L.; Morton, R.; Ostermann, B.; Bilinska, M.; Rose, J.; Reece-Anthony, B. O.; Ryan, R.; Hamilton, C.; Hopkins, M.; Wendon, P.; Brescia, J.; Ijaz, G.; Wood, N.; George, J.; Toth-Tarsoly, M.; Yates, P.; Armstrong, B.; Scott, M.; Boyd, C.; Szakmany, C.; Rees, T.; Pulak, D.; Coggon, P.; Saha, M.; Kent, B.; Gibson, L.; Camsooksai, B.; Reschreiter, J.; Morgan, H.; Sangaralingham, P.; Lowe, S.; Vondras, A.; Jamadarkhana, P.; Cruz, S.; Bhandary, C.; Hersey, R.; Furneval, P.; Innes, J.; Doble, R.; Attwood, P.; Parsons, B.; Page, P.; Zhao, V.; Grecu, X.; Dalton, I.; Hegazy, J.; Awad, M.; Naylor, Y.; Naylor, D.; Lee, A.; Brevard, S.; Davis, S.

doi:10.1007/s00134-019-05819-3

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.