Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

• Type of Material: Article
• Authors: Jan De Waele, Ghent University Hospital; Jeffrey Lipman, The University of Queensland; Yasser Sakr, Friedrich-Schiller-University; John C. Marshall, University of Toronto; Philippe Vanhems, Université Lyon 1; Casiano Barrera Groba, Brighton and Sussex University Hospitals NHS Trust; Marc Leone, Aix-Marseille University; Jean-Louis Vincent, Université Libre de Bruxelles; Greg Martin, Emory University
• Language: English
• Date: 2014-12
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © De Waele et al.; licensee BioMed Central Ltd. 2014
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/1471-2334-14-420
• Title of Journal or Parent Work: BMC Infectious Diseases
• ISSN: 1471-2334
• Volume: 14
• Issue: 1
• Keywords: Peritonitis; Critical care; Antibiotic therapy; Severe sepsis; Abdominal infection; Microbiology; Abscess
• Research Categories: Health Sciences, General; Health Sciences, Health Care Management

Abstract

Background Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. Go to: Methods EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. Go to: Results Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. Conclusions The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.