Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecifc characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. ecent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fuoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

Savino Spadaro
Membro del Collaboration Group
;
Carlo Volta
Membro del Collaboration Group
;
2021

Abstract

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecifc characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. ecent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fuoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.
2021
Francois, Guy; Labeau, Sonia; Blot, Koen; Deschepper, Mieke; Antonelli, Massimo; Lipman, Jeffrey; Vogelaers, Dirk; Lamrous, Amin; Pereyra, Cecilia; Lipovestky, Fernando; Koulenti, Despoina; De Waele, Jan; Rezende-Neto, Joao; Cardenas, Yenny; Vymazal, Tomas; Fjeldsoee-Nielsen, Hans; Montravers, Philippe; Kott, Matthias; Kostoula, Arvaniti; Javeri, Yash; Girardis, Massimo; Einav, Sharon; de Lange, Dylan; Daniel Umezawa Makikado, Luis; Mikstacki, Adam; Paiva, José-Artur; Tomescu, Dana; Gritsan, Alexey; Jovanovic, Bojan; Venkatesan, Kumaresh; Mirkovic, Tomislav; Maseda, Emilio; Dikmen, Yalim; Creagh-Brown, Benedict; Lamrous, Amin; Emmerich, Monica; Canale, Mariana; Silvina Dietz, Lorena; Ilutovich, Santiago; Thomas Sanchez Miñope, John; Baldomera Silva, Ramona; Alexis Montenegro, Martin; Martin, Patricio; Saul, Pablo; Chediack, Viviana; Sutton, Giselle; Couce, Rocio; Balasini, Carina; Gonzalez, Susana; Maria Lascar, Florencia; Jorge Descotte, Emiliano; Soledad Gumiela, Natalia; Alejandra Pino, Carina; Cesio, Cristian; Valgolio, Emanuel; Cunto, Eleonora; Dominguez, Cecilia; Lipovestky, Fernando; Funes Nelson, Nydia; Martin Abegao, Esteban; Pereyra, Cecilia; Christian Pozo, Norberto; Bianchi, Luciana; Correger, Enrique; Laura Pastorino, Maria; Aurora Miyazaki, Erica; Christian Pozo, Norberto; Grubissich, Nicolas; Garcia, Mariel; Bonetto, Natalia; Elizabeth Quevedo, Noelia; Delia Gomez, Cristina; Queti, Felipe; Gonzalez Estevarena, Luis; Fernandez, Ruben; Santolaya, Ignacio; Christian Pozo, Norberto; Hugo Grangeat, Sergio; Doglia, Juan; Zakalik, Graciela; Pellegrini, Carlos; Monserrat Lloria, Maria; Esteban Chacon, Mercedes; Fumale, Mariela; Leguizamon, Mariela; Beatriz Hidalgo, Irene; Julian Tiranti, Roberto; Capponi, Paola; Tita, Agustin; Cardonnet, Luis; Bettini, Lisandro; Ramos, Agñel; Lovesio, Luciano; Miriam Miranda, Edith; Beatriz Farfan, Angelica; Tolosa, Carina; Segura, Lise; Bellocchio, Adelina; Alvarez, Brian; Manzur, Adriana; Lujan, Rodolfo; Fernandez, Natalia; Scarone, Nahuel; Zazu, Alan; Groh, Carina; Fletcher, Jason; Smith, Julie; Azad, Raman; Chavan, Nitin; Wong, Helen; Kol, Mark; Campbell, Lewis; Koulenti, Despoina; Starr, Therese; Roberts, Brigit; Wibrow, Bradley; Warhurst, Timothy; Chinthamuneedi, Meher; Buitrago Ferney, Bernal; Simon, Marc; De Backer, Daniel; Wittebole, Xavier; De Bels, David; Collin, Vincent; Dams, Karolien; Jorens, Philippe; De Waele, Jan; Dubois, Jasperina; Gunst, Jan; Haentjens, Lionel; De Schryver, Nicolas; Dugernier, Thierry; Rezende-Neto, Joao; Rizoli, Sandro; Santillan, Paul; Han, Yi; Biskup, Ewelina; Qu, Changjing; Li, Xinyu; Yu, Tao; Weihua, Lu; Molano-Franco, Daniel; Rojas, José; Mauricio Pardo Oviedo, Juan; Pinilla, Dario; Cardenas, Yenny; Celis, Edgar; Arias, Mario; Vukovic, Anita; Vudrag, Maja; Belavic, Matija; Zunic, Josip; Kuharic, Janja; Bozanic Kricka, Irena; Filipovic-Grcic, Ina; Tomasevic, Boris; Obraz, Melanija; Bodulica, Bruna; Dohnal, Martin; Malaska, Jan; Kratochvil, Milan; Satinsky, Igor; Schwarz, Peter; Kos, Zdenek; Blahut, Ladislav; Maca, Jan; Protus, Marek; Kieslichová, Eva; Gramstrup Nielsen, Louise; Marianne Krogh, Birgitte; Rivadeneira, Francisco; Morales, Freddy; Mora, José; Saraguro Orozco, Alexandra; Rolando MorochoTutillo, Diego; Remache Vargas, Nelson; Salgado Yepez, Estuardo; Villamagua, Boris; Alsisi, Adel; Fahmy, Abdelraouf; Dupont, Hervé; Lasocki, Sigismond; Paugam-Burtz, Catherine; Foucrier, Arnaud; Nica, Alexandru; Barjon, Geneviève; Mallat, Jihad; Marcotte, Guillaume; Leone, Marc; Duclos, Gary; Burtin, Philippe; Montravers, Philippe; Atchade, Enora; Mahjoub, Yazine; Misset, Benoît; Timsit, Jean-François; Dupuis, Claire; Veber, Benoît; Debarre, Matthieu; Collange, Oliver; Pottecher, Julien; Hecketsweiler, Stephane; Fromentin, Mélanie; Tesnière, Antoine; Koch, Christian; Sander, Michael; Kott, Matthias; Eckmann, Christian; Elke, Gunnar; Wrigge, Hermann; Simon, Philipp; Chalkiadaki, Anthoula; Tzanidakis, Charalampos; Pneumatikos, Ioannis; Sertaridou, Eleni; Mastora, Zafiria; Pantazopoulos, Ioannis; Papanikolaou, Metaxia; Papavasilopoulou, Theonymfi; Floros, John; Kolonia, Virginia; Dimopoulos, George; Diakaki, Chryssa; Rallis, Michael; Paridou, Alexandra; Kalogeromitros, Alexandros; Romanou, Vasiliki; Nikolaou, Charikleia; Kounougeri, Katerina; Tsigou, Evdoxia; Psallida, Vasiliki; Karampela, Niki; Mandragos, Konstantinos; Kontoudaki, Eftychia; Pentheroudaki, Alexandra; Farazi-Chongouki, Christos; Karakosta, Agathi; Chouris, Isaac; Radu, Vasiliki; Malliotakis, Polychronis; Kokkini, Sofia; Charalambous, Eliana; Kyritsi, Aikaterini; Koulouras, Vasilios; Papathanakos, Georgios; Nagky, Eva; Lampiri, Clairi; Tsimpoukas, Fotios; Sarakatsanos, Ioannis; Georgakopoulos, Panagiotis; Ravani, Ifigeneia; Prekates, Athanasios; Sakellaridis, Konstantinos; Christopoulos, Christos; Vrettou, Efstratia; Stokkos, Konstantinos; Pentari, Anastasia; Arvaniti, Kostoula; Marmanidou, Kyriaki; Kydona, Christina; Tsoumaropoulos, Georgios; Bitzani, Militisa; Kontou, Paschalina; Voudouris, Antonios; Flioni, Elli-Nikki; Antypa, Elli; Chasou, Eleftheria; Anisoglou, Souzana; Papageorgiou, Eirini; Paraforou, Theoniki; Tsioka, Agoritsa; Karathanou, Antigoni; Vakalos, Aristeidis; Shah, Bhagyesh; Thakkar, Chirag; Jain, Nikhilesh; Gurjar, Mohan; Baronia, Arvind; Sathe, Prachee; Kulkarni, Shilpa; Paul, Cherish; Paul, John; Masjedi, Mansoor; Nikandish, Reza; Zand, Farid; Sabetian, Golnar; Mahmoodpoor, Ata; Mohammadreza Hashemian, Seyed; Bala, Miklosh; Flocco, Romeo; Torrente, Sergio; Pota, Vincenzo; Spadaro, Savino; Volta, Carlo Alberto; Girardis, Massimo; Serafini, Giulia; Boraso, Sabrina; Tiberio, Ivo; Cortegiani, Andrea; Misseri, Giovanni; Barbagallo, Maria; Nicolotti, Davide; Forfori, Francesco; Corradi, Francesco; Antonelli, Massimo; De Pascale, Gennaro; Pelagalli, Lorella; Brazzi, Luca; Giorgio Vittone, Ferdinando; Russo, Alessandro; Simion, Davide; Cotoia, Antonella; Cinnella, Gilda; Toppin, Patrick; Johnson-Jackson, Roxanne; Hayashi, Yoshiro; Yamamoto, Ryohei; Yasuda, Hideto; Kishihara, Yuki; Shiotsuka, Junji; Alejandro Sanchez-Hurtado, Luis; Tejeda-Huezo, Brigitte; Gorordo, Luis; A Ñamendys-Silva, Silvio; J Garcia-Guillen, Francisco; Martinez, Manuel; Romero-Meja, Erick; Colorado-Dominguez, Ever; van den Oever, Huub; Martijn Kalff, Karel; Vermeijden, Wytze; Daniel Cornet, Alexander; Beck, Oliver; Cimic, Nedim; Dormans, Tom; Bormans, Laura; Bakker, Jan; Van Duijn, Ditty; Bosman, Gerrit; Vos, Piet; de Lange, Dylan; Haas, Lenneke; Henein, Akram; M Miranda, Ariel; Daniel Umezawa Makikado, Luis; Ernesto Gianella Malca, Gonzalo; Arroyo-Sanchez, Abel; Misiewska-Kaczur, Agnieszka; Akinyi, Frisch; Czuczwar, Miroslaw; Luczak, Karolina; Sulkowski, Wiktor; Tamowicz, Barbara; Mikstacki, Adam; Swit, Beata; Baranowski, Bronisław; Smuszkiewicz, Piotr; Trojanowska, Iwona; Rzymski, Stanislaw; Sawinski, Mariusz; Trosiak, Marta; Mikaszewska-Sokolewicz, Malgorzata; Alves, Ricardo; Leal, Dina; Krystopchuk, Andriy; Muguel Hilario Mendonca, Pedro; Antunes Pereira, Rui; Raquel Lopes Marques de Carvalho, Maria; Candeias, Carlos; Molinos, Elena; Ferreira, Amélia; Castro, Guiomar; Paiva, José-Artur; Pereira, José-Manuel; Santos, Lurdes; Ferreira, Alcina; Pascoalinho, Dulce; Ribeiro, Rosa; Domingos, Guilherme; Gomes, Pedro; Nora, David; Pedro Costa, Rui; Santos, Anabela; Subhy Alsheikhly, Ahmed; Tomescu, Dana; Popescu, Mihai; Grigoras, Ioana; Patrascanu, Emilia; Zabolotskikh, Igor; Musaeva, Tatiana; Gritsan, Alexey; Gaigolnik, Denis; Kulabukhov, Vladimir; Belskiy, Vladislav; Zubareva, Nadezhda; Tribulev, Maxim; Abdelsalam, Ahmed; Aldarsani, Ayman; Al-Khalid, Muhammad; Almekhlafi, Ghaleb; Mandourah, Yasser; Jovanovic, Bojan; Doklestic, Krstina; Velickovic, Jelena; Velickovic, Dejan; Jankovic, Radmilo; Vukovic, Anita; Skoric-Jokic, Svetlana; Radovanovic, Dragana; Richards, Guy; Alli, Ahmad; Del Carmen Cordoba Nielfa, Maria; Sánchez Iniesta, Rafael; Benítez-Cano Martínez, Adela; Garcia Bernedo, Carlos; Alberto Picos Gil, Santiago; Nuvials, Xavier; Rello, Jordi; Gonzalez Garcia, Joseba; Manuel Garcia Peña, Jose; Jimenez, Roberto; Herrera, Luis; Galarza Barrachina, Laura; Catalan Monzon, Ignacio; Javier Redondo, Francisco; Villazala, Ruben; Fernando Matallana Zapata, Diego; Maria Villa Lopez, Isabel; Moreno-Gonzalez, Gabriel; Carlos Lopez-Delgado, Juan; Solera Marin, Jorge; Sanchez-Zamora, Purificacion; Vallverdú Vidal, Montserrat; Flores González, Jesús; Salinas, Irene; Hermosa, Cecilia; Maseda, Emilio; Martinez-Sagasti, Fernando; Domingo-Marín, Sara; Abril Victorino, Johanna; Garcia-Alvarez, Raquel; López-Arcas Calleja, Pablo; de la Torre-Prados, Maria-Victoria; Vidal-Cortes, Pablo; Del Río-Carbajo, Lorena; Izura, Javier; Minguez, Victoria; Trenado Alvarez, Josep; Parera Prous, Anna; Paz, Daniel; Roche-Campo, Ferran; Aguilar, Gerardo; Belda, Javier; Rico-Feijoo, Jesus; Aldecoa, Cesat; Zalba-Etayo, Begoña; Lang, Martin; Dullenkopf, Alexander; Trongtrakul, Konlawij; Chtsomkasem, Anusang; Akbaş, Türkay; Necmettin Unal, Mustafa; Ozcelik, Menekse; Gumus, Ayca; Ramazanoglu, Atilla; Memis, Dilek; Mehmet, Inal; Dikmen, Yalim; Urkmez, Seval; Ozgultekin, Asu; Demirkiran, Oktay; Ahu Aslan, Nesrin; Kizilaslan, Deniz; Kahveci, Ferda; Ünlü, Nurdan; Ozkan, Zeynep; Kaye, Callum; Jansen, Jan; O'Neill, Orla; Nutt, Christopher; Jha, Rajeev; Hooker, Nicolas; Grecu, Irina; Petridou, Christina; Shyamsundar, Murali; Mcnamee, Lia; Trinder, John; Hagan, Samantha; Kelly, Catriona; Silversides, Jonathon; Barrera Groba, Casiano; Boyd, Owen; Bhowmick, Kaushik; Humphreys, Sally; Summers, Charlotte; Polgarova, Petra; Margarson, Michael; Dickens, Justin; Pearson, Suzanne; Chinery, Elaine; Hemmings, Noel; O'Kane, Sinead; Austin, Pauline; Cole, Stephen; Plowright, Catherine; Box, Roberta; Wright, Christopher; Young, Lorna; Creagh-Brown, Ben; Montague, Laura; Parker, Robert; Morton, Ben; Ostermann, Marlies; Bilinska, Julia; Oliver Rose, Bernd; Reece-Anthony, Rosie; Ryan, Christine; Hamilton, Mark; Hopkins, Philip; Wendon, Julia; Brescia, Giovanni; Ijaz, Nazia; Wood, James; George, Michelle; Toth-Tarsoly, Piroska; Yates, Bryan; Armstrong, Maureen; Scott, Carmen; Boyd, Christine; Szakmany, Tamas; Rees, David; Pulak, Paul; Coggon, Mandy; Saha, Bhaskar; Kent, Linda; Gibson, Bethan; Camsooksai, Julie; Reschreiter, Henrik; Morgan, Pat; Sangaralingham, Sivatharshini; Lowe, Alastair; Vondras, Petr; Jamadarkhana, Sunil; Cruz, Carina; Bhandary, Rakesh; Hersey, Peter; Furneval, Julie; Innes, Richard; Doble, Patricia; Attwood, Ben; Parsons, Penny; Page, Valerie; Zhao, Xiaobei; Grecu, Irina; Dalton, Julian; Hegazy, Mohammed; Awad, Yasser; Naylor, Douglas; Naylor, Amanda; Lee, Sarah; Brevard, Sidney; Davis, Noelle
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