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IRIS
Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.
Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units
Vogelaers D.;Blot S.;Van den Berge A.;Montravers P.;Francois G.;Labeau S.;Blot K.;Deschepper M.;Antonelli M.;Lipman J.;Lamrous A.;Pereyra C.;Lipovestky F.;Koulenti D.;De Waele J.;Rezende-Neto J.;Cardenas Y.;Vymazal T.;Fjeldsoee-Nielsen H.;Kott M.;Kostoula A.;Javeri Y.;Girardis M.;Einav S.;de Lange D.;Makikado L. D. U.;Mikstacki A.;Paiva J. -A.;Tomescu D.;Gritsan A.;Jovanovic B.;Venkatesan K.;Mirkovic T.;Maseda E.;Dikmen Y.;Creagh-Brown B.;Lamrous A.;Emmerich M.;Canale M.;Dietz L. S.;Ilutovich S.;Minope 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.;Lipovestky F.;Nelson N. F.;Abegao E. M.;Pereyra C.;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.;Koulenti D.;Starr T.;Roberts B.;Wibrow B.;Warhurst T.;Chinthamuneedi M.;Ferney B. B.;Simon M.;De Backer D.;Wittebole X.;De Bels D.;Collin V.;Dams K.;Jorens P.;De Waele J.;Dubois J.;Gunst J.;Haentjens L.;De Schryver N.;Dugernier T.;Rezende-Neto J.;Rizoli S.;Santillan P.;Han Y.;Biskup E.;Qu C.;Li X.;Yu T.;Weihua L.;Molano-Franco D.;Rojas J.;Oviedo J. M. P.;Pinilla D.;Cardenas Y.;Celis E.;Arias M.;Vukovic A.;Vudrag M.;Belavic M.;Zunic J.;Kuharic J.;Kricka I. B.;Filipovic-Grcic I.;Tomasevic B.;Obraz M.;Bodulica B.;Dohnal M.;Malaska J.;Kratochvil M.;Satinsky I.;Schwarz P.;Kos Z.;Blahut L.;Maca J.;Protus M.;Kieslichova E.;Nielsen L. G.;Krogh B. M.;Rivadeneira F.;Morales F.;Mora J.;Orozco A. S.;MorochoTutillo D. R.;Vargas N. R.;Yepez E. S.;Villamagua B.;Alsisi A.;Fahmy A.;Dupont H.;Lasocki S.;Paugam-Burtz C.;Foucrier A.;Nica A.;Barjon G.;Mallat J.;Marcotte G.;Leone M.;Duclos G.;Burtin P.;Atchade E.;Mahjoub Y.;Misset B.;Timsit J. -F.;Dupuis C.;Veber B.;Debarre M.;Collange O.;Pottecher J.;Hecketsweiler S.;Fromentin M.;Tesniere A.;Koch C.;Sander M.;Kott M.;Eckmann C.;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.;Dimopoulos G.;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.;Arvaniti K.;Marmanidou K.;Kydona C.;Tsoumaropoulos G.;Bitzani M.;Kontou P.;Voudouris A.;Elli-Nikki Flioni;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.;Girardis M.;Serafini G.;Boraso S.;Tiberio I.;Cortegiani A.;Misseri G.;Barbagallo M.;Nicolotti D.;Forfori F.;Corradi F.;Antonelli M.;De Pascale G.;Pelagalli L.;Brazzi L.;Vittone F. G.;Russo A.;Simion D.;Cotoia A.;Cinnella G.;Toppin P.;Johnson-Jackson R.;Hayashi Y.;Yamamoto R.;Yasuda H.;Kishihara Y.;Shiotsuka J.;Sanchez-Hurtado L. A.;Tejeda-Huezo B.;Gorordo L.;Namendys-Silva S. A.;Garcia-Guillen F. J.;Martinez M.;Romero-Meja E.;Colorado-Dominguez E.;van den Oever H.;Kalff K. M.;Vermeijden W.;Cornet A. D.;Beck O.;Cimic N.;Dormans T.;Bormans L.;Bakker J.;Van Duijn D.;Bosman G.;Vos P.;de Lange D.;Haas L.;Henein A.;Miranda A. M.;Makikado L. D. U.;Malca G. E. G.;Arroyo-Sanchez A.;Misiewska-Kaczur A.;Akinyi F.;Czuczwar M.;Luczak K.;Sulkowski W.;Tamowicz B.;Mikstacki A.;Swit B.;Baranowski B.;Smuszkiewicz P.;Trojanowska I.;Rzymski S.;Sawinski M.;Trosiak M.;Mikaszewska-Sokolewicz M.;Alves R.;Leal D.;Krystopchuk A.;Mendonca P. M. H.;Pereira R. A.;de Carvalho M. R. L. M.;Candeias C.;Molinos E.;Ferreira A.;Castro G.;Paiva J. -A.;Pereira 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 M.;Iniesta R. S.;Martinez A. B. -C.;Bernedo C. G.;Gil S. A. P.;Nuvials X.;Rello J.;Garcia J. G.;Pena 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.;Gonzalez J. F.;Salinas I.;Hermosa C.;Maseda E.;Martinez-Sagasti F.;Domingo-Marin S.;Victorino J. A.;Garcia-Alvarez R.;Calleja P. L. -A.;de la Torre-Prados M. -V.;Vidal-Cortes P.;Del Rio-Carbajo L.;Izura J.;Minguez V.;Alvarez J. T.;Prous A. P.;Paz D.;Roche-Campo F.;Aguilar G.;Belda J.;Rico-Feijoo J.;Aldecoa C.;Zalba-Etayo B.;Lang M.;Dullenkopf A.;Trongtrakul K.;Chtsomkasem A.;Akbas T.;Unal M. N.;Ozcelik M.;Gumus A.;Ramazanoglu A.;Memis D.;Mehmet I.;Dikmen Y.;Urkmez S.;Ozgultekin A.;Demirkiran O.;Aslan N. A.;Kizilaslan D.;Kahveci F.;Unlu N.;Ozkan Z.;Kaye C.;Jansen J.;O'Neill O.;Nutt C.;Jha R.;Hooker N.;Grecu I.;Petridou C.;Shyamsundar M.;McNamee L.;Trinder J.;Hagan S.;Kelly C.;Silversides J.;Groba C. B.;Boyd O.;Bhowmick K.;Humphreys S.;Summers C.;Polgarova P.;Margarson M.;Dickens J.;Pearson S.;Chinery E.;Hemmings N.;O'Kane S.;Austin P.;Cole S.;Plowright C.;Box R.;Wright C.;Young L.;Creagh-Brown B.;Montague L.;Parker R.;Morton B.;Ostermann M.;Bilinska J.;Rose B. O.;Reece-Anthony R.;Ryan C.;Hamilton M.;Hopkins P.;Wendon J.;Brescia G.;Ijaz N.;Wood J.;George M.;Toth-Tarsoly P.;Yates B.;Armstrong M.;Scott C.;Boyd C.;Szakmany T.;Rees D.;Pulak P.;Coggon M.;Saha B.;Kent L.;Gibson B.;Camsooksai J.;Reschreiter H.;Morgan P.;Sangaralingham S.;Lowe A.;Vondras P.;Jamadarkhana S.;Cruz C.;Bhandary R.;Hersey P.;Furneval J.;Innes R.;Doble P.;Attwood B.;Parsons P.;Page V.;Zhao X.;Grecu I.;Dalton J.;Hegazy M.;Awad Y.;Naylor D.;Naylor A.;Lee S.;Brevard S.;Davis N.
2021
Abstract
Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11591/452085
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
