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PLoS One. 2019 Sep 26;14(9):e0223092. doi: 10.1371/journal.pone.0223092. eCollection 2019.

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

Author information

1
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.
2
Universidad Autónoma de Madrid, Madrid, Spain.
3
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Central de Asturias, Oviedo, Spain.
4
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Vall d'Hebron, Barcelona, Spain.
5
Anesthesiology and Surgical Critical Care Dpt., Hospital del Mar, Barcelona, Spain.
6
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
7
Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario, Valencia, Spain.
8
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario Basurto, Bilbao, Spain.
9
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
10
Anesthesiology and Surgical Critical Care Dpt., Hospital Virgen de la Salud, Toledo, Spain.
11
Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario, Valladolid, Spain.
12
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario de la Princesa, Madrid, Spain.
13
Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario 12 de Octubre, Madrid, Spain.
14
Anesthesiology and Surgical Critical Care Dpt., Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
15
PRISM-AG, Madrid, Spain.
16
Universidad Europea, Madrid, Spain.

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.

Conflict of interest statement

E.M. has served as speaker for Merck, Sharp & Dohme (MSD), Pfizer and Astellas; and has received educational grants from Astellas. F.R. has served as speaker for MSD. G.A. has served as speaker for MSD, Astellas, Gilead, and Pfizer and received educational grants from Astellas, Pfizer and MSD. M-JG is employee of PRISM-AG and has received an educational grant from Fundación Micellium para el Desarrollo y Difusión del Conocimiento Científico (Valencia, Spain). The remaining authors have disclosed that they do not have any potential conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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