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. eCollection 2019.

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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / drug effects*
  • Bacteria / isolation & purification
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology*
  • Community-Acquired Infections / mortality
  • Critical Illness / mortality
  • Critical Illness / therapy
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy
  • Cross Infection / microbiology*
  • Cross Infection / mortality
  • Drug Resistance, Bacterial*
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Intraabdominal Infections / diagnosis
  • Intraabdominal Infections / drug therapy
  • Intraabdominal Infections / microbiology*
  • Intraabdominal Infections / mortality
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Spain / epidemiology

Substances

  • Anti-Bacterial Agents

Grants and funding

This multicentre study was possible due to the generous implication of the personnel in the 17 participating ICUs. The study did not receive external funding. One of the authors [MJG] is employee of a commercial company (PRISM-AG) which was not funder of the present study. This company only provided support in the form of the salary for this author [MJG], but did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.