Maseda, EmilioRamírez, SofíaPicatto, PedroPeláez-Peláez, EvaGarcía-Bernedo, Carlos A.Ojeda-Betancur, NazarioAguilar, GerardoForés, BeatrizSolera-Marín, JorgeAliaño-Piña, MaríaTamayo Aguirre, EduardoRamasco Rueda, FernandoGarcía-Álvarez, RaquelGonzález-Lisorge, AdaGiménez, Maria-JoséSuárez-de-la-Rica, AlejandroHELP Investigators and the Perioperative Infection Research Group2020-03-302020-03-302019Maseda 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.02230921932-6203http://hdl.handle.net/10230/44085The 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.application/pdfeng© 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.Abdomen--MalaltiesAbdomen--InfeccionsMortalitatinfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1371/journal.pone.0223092info:eu-repo/semantics/openAccess