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


Autoři: Emilio Maseda aff001;  Sofía Ramírez aff001;  Pedro Picatto aff003;  Eva Peláez-Peláez aff004;  Carlos García-Bernedo aff005;  Nazario Ojeda-Betancur aff006;  Gerardo Aguilar aff007;  Beatriz Forés aff008;  Jorge Solera-Marín aff009;  María Aliaño-Piña aff010;  Eduardo Tamayo aff011;  Fernando Ramasco aff012;  Raquel García-Álvarez aff013;  Ada González-Lisorge aff014;  María-José Giménez aff015;  Alejandro Suárez-de-la-Rica aff0010
Působiště autorů: Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain aff001;  Universidad Autónoma de Madrid, Madrid, Spain aff002;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Central de Asturias, Oviedo, Spain aff003;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Vall d’Hebron, Barcelona, Spain aff004;  Anesthesiology and Surgical Critical Care Dpt., Hospital del Mar, Barcelona, Spain aff005;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain aff006;  Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario, Valencia, Spain aff007;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Basurto, Bilbao, Spain aff008;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain aff009;  Anesthesiology and Surgical Critical Care Dpt., Hospital Virgen de la Salud, Toledo, Spain aff010;  Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario, Valladolid, Spain aff011;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de la Princesa, Madrid, Spain aff012;  Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario 12 de Octubre, Madrid, Spain aff013;  Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain aff014;  PRISM-AG, Madrid, Spain aff015;  Universidad Europea, Madrid, Spain aff016
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223092

Souhrn

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.

Klíčová slova:

Antimicrobial resistance – Antimicrobials – Candida – Death rates – Intensive care units – Nosocomial infections – Peritonitis – Ascites


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