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Observational Study
. 2019 Dec;45(12):1703-1717.
doi: 10.1007/s00134-019-05819-3. Epub 2019 Oct 29.

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

Stijn Blot  1 , Massimo Antonelli  2   3 , Kostoula Arvaniti  4 , Koen Blot  5 , Ben Creagh-Brown  6   7 , Dylan de Lange  8 , Jan De Waele  9 , Mieke Deschepper  10 , Yalim Dikmen  11 , George Dimopoulos  12 , Christian Eckmann  13 , Guy Francois  14 , Massimo Girardis  15 , Despoina Koulenti  16   17 , Sonia Labeau  5   18 , Jeffrey Lipman  19   20 , Fernando Lipovestky  21 , Emilio Maseda  22 , Philippe Montravers  23   24 , Adam Mikstacki  25   26 , José-Artur Paiva  27 , Cecilia Pereyra  28 , Jordi Rello  29 , Jean-Francois Timsit  30   31 , Dirk Vogelaers  32 ; Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine
Collaborators, Affiliations
Observational Study

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

Stijn Blot et al. Intensive Care Med. 2019 Dec.

Abstract

Purpose: To 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).

Methods: We 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.

Results: The 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.

Conclusion: This 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.

Keywords: Intensive care; Intra-abdominal infection; Mortality; Multidrug resistance; Peritonitis; Sepsis.

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Conflict of interest statement

Received grants related to the submitted work: S. Blot (Pfizer). Received honoraria or grants outside the submitted work: M. Antonelli (Fresenius, Pfizer, Toray); J. De Waele (Research Foundation Flanders, Pfizer, Bayer, MSD); C. Eckmann (Merck, Pfizer); J. Lipman (MSD, Pfizer); E. Maseda (Astellas Pharma, Pfizer, MSD); All other authors: no conflict of interest.

Figures

Fig. 1
Fig. 1
Types of microbiological cultures sampled and culture-positive rate in patients with intra-abdominal infection
Fig. 2
Fig. 2
Initial approach to control the source of infection. Several types of source control interventions could have been executed in a single patient
See this image and copyright information in PMC

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