Critically ill patients with community-onset intraabdominal infections: influence of healthcare exposure on resistance rates and mortality

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  • dc.contributor.author Maseda, Emilio
  • dc.contributor.author Ramírez, Sofía
  • dc.contributor.author Picatto, Pedro
  • dc.contributor.author Peláez-Peláez, Eva
  • dc.contributor.author García-Bernedo, Carlos A.
  • dc.contributor.author Ojeda-Betancur, Nazario
  • dc.contributor.author Aguilar, Gerardo
  • dc.contributor.author Forés, Beatriz
  • dc.contributor.author Solera-Marín, Jorge
  • dc.contributor.author Aliaño-Piña, María
  • dc.contributor.author Tamayo Aguirre, Eduardo
  • dc.contributor.author Ramasco Rueda, Fernando
  • dc.contributor.author García-Álvarez, Raquel
  • dc.contributor.author González-Lisorge, Ada
  • dc.contributor.author Giménez, Maria-José
  • dc.contributor.author Suárez-de-la-Rica, Alejandro
  • dc.contributor.author HELP Investigators and the Perioperative Infection Research Group
  • dc.date.accessioned 2020-03-30T06:27:37Z
  • dc.date.available 2020-03-30T06:27:37Z
  • dc.date.issued 2019
  • dc.description.abstract The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non-postoperative/non-nosocomial) in patients admitted to intensive care units (ICUs), to investigate differences in resistance patterns linked to healthcare exposure and mortality-associated factors. A one-year prospective observational study (17 Spanish ICUs) was performed distributing cases as healthcare-associated infections (HCAI), community-acquired infections (CAI) and immunocompromised patients (ICP). Bacteria producing extended-spectrum β-lactamases (ESBL) and/or carbapenemase (CPE), high-level aminoglycoside- and/or methicillin- and/or vancomycin- resistance were considered antimicrobial resistant (AMR). Mortality-associated factors were identified by regression multivariate analysis. Of 345 patients included (18.8% HCAI, 6.1% ICP, 75.1% CAI), 51.6% presented generalized peritonitis; 32.5% were >75 years (55.4% among HCAI). Overall, 11.0% cases presented AMR (7.0% ESBL- and/or CPE), being significantly higher in HCAI (35.4%) vs. CAI (5.8%) (p<0.001) vs. ICP (0%) (p = 0.003). Overall 30-day mortality was 14.5%: 23.1% for HCAI and 11.6% for CAI (p = 0.016). Mortality (R2 = 0.262, p = 0.021) was positively associated with age >75 years (OR = 6.67, 95%CI = 2.56-17.36,p<0.001), Candida isolation (OR = 3.05, 95%CI = 1.18-7.87,p = 0.022), and SAPS II (per-point, OR = 1.08, 95%CI = 1.05-1.11, p<0.001) and negatively with biliary infections (OR = 0.06, 95%CI = 0.01-0.48,p = 0.008). In this study, the antimicrobial susceptibility pattern of bacteria isolated from patients with healthcare contact was shifted to resistance, suggesting the need for consideration of the healthcare category (not including hospital-acquired infections) for severe IAIs. 30-day mortality was positively related with age >75 years, severity and Candida isolation but not with AMR.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Maseda E, Ramírez S, Picatto P, Peláez-Peláez E, García-Bernedo C, Ojeda-Betancur N, et al. Critically ill patients with community-onset intraabdominal infections: influence of healthcare exposure on resistance rates and mortality. PLoS One. 2019 Sep 26; 14(9):e0223092. DOI: 10.1371/journal.pone.0223092
  • dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0223092
  • dc.identifier.issn 1932-6203
  • dc.identifier.uri http://hdl.handle.net/10230/44085
  • dc.language.iso eng
  • dc.publisher Public Library of Science (PLoS)
  • dc.rights © 2019 Maseda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/ which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri https://creativecommons.org/licenses/by/4.0/
  • dc.subject.other Abdomen--Malalties
  • dc.subject.other Abdomen--Infeccions
  • dc.subject.other Mortalitat
  • dc.title Critically ill patients with community-onset intraabdominal infections: influence of healthcare exposure on resistance rates and mortality
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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