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

Blot, S.; Antonelli, M.; Arvaniti, K.; Blot, K.; Creagh-Brown, B.; de Lange, D.; De Waele, J.; Deschepper, M.; Dikmen, Y.; Dimopoulos, G.; Eckmann, C.; Francois, G.; Girardis, M.; Koulenti, D.; Labeau, S.; Lipman, J.; Lipovestky, F.; Maseda, E.; Montravers, P.; Mikstacki, A.; Paiva, J. -A.; Pereyra, C.; Rello, J.; Timsit, J. -F.; Vogelaers, 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.; 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.; 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.; De Backer, D.; Wittebole, X.; De Bels, D.; Collin, V.; Dams, K.; Jorens, P.; 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.; 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.; 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.; 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.; 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.; 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.; 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.; 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.; 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.; 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.; 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.

doi:10.1007/s00134-019-05819-3

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.