Critically ill patients with community-onset intraabdominal infections : Influence of healthcare exposure on resistance rates and mortality
Maseda, Emilio (Universidad Autónoma de Madrid)
Ramírez, Sofía (Universidad Autónoma de Madrid)
Picatto, Pedro (Hospital Universitario Central de Asturias)
Peláez-Peláez, Eva (Hospital Universitari Vall d'Hebron)
García-Bernedo, Carlos A. (Hospital del Mar (Barcelona, Catalunya))
Ojeda-Betancur, Nazario (Hospital Universitario de Gran Canaria Dr. Negrín)
Aguilar, Gerardo (Hospital Clínic Universitari (València))
Forés, Beatriz (Hospital de Basurto (Bilbao, Biscaia))
Solera-Marín, Jorge (Hospital Universitario de Canarias (La Laguna))
Aliaño-Piña, María (Hospital Virgen de la Salud (Toledo))
Tamayo, Eduardo (Hospital Clínico Universitario de Valladolid)
Ramasco, Fernando (Hospital Universitario de la Princesa (Madrid))
García-Álvarez, Raquel (Hospital Universitario 12 de Octubre (Madrid))
González-Lisorge, Ada (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Giménez, María-José (Universidad Europea de Madrid)
Suárez-de-la-Rica, Alejandro (Universidad Autónoma de Madrid)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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 (R 2 = 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.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 14 (september 2019) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0223092
PMID: 31557256

12 p, 550.3 KB

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