Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome
Identifieur interne : 003C35 ( Main/Exploration ); précédent : 003C34; suivant : 003C36Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome
Auteurs : Jan De Waele [Belgique] ; Jeffrey Lipman ; Yasser Sakr [Allemagne] ; John C. Marshall [Canada] ; Philippe Vanhems [France] ; Casiano Barrera Groba ; Marc Leone [France] ; Jean-Louis Vincent [Belgique]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2014.
Abstract
Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.
EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.
Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more
The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.
The online version of this article (doi:10.1186/1471-2334-14-420) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/1471-2334-14-420
PubMed: 25074742
PubMed Central: 4122779
Affiliations:
- Allemagne, Belgique, Canada, France
- Ontario, Provence-Alpes-Côte d'Azur, Province de Flandre-Orientale, Vienne (Autriche)
- Bruxelles, Gand, Marseille, Toronto, Vienne (Autriche)
- Université de Toronto, Université libre de Bruxelles
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Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Chemin des Bourrely, 13015 Marseille</wicri:regionArea><wicri:noRegion>13015 Marseille</wicri:noRegion><placeName><settlement type="city">Marseille</settlement><region type="région" nuts="2">Provence-Alpes-Côte d'Azur</region></placeName></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><nlm:aff id="Aff8">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement><settlement type="city">Bruxelles</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25074742</idno><idno type="pmc">4122779</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122779</idno><idno type="RBID">PMC:4122779</idno><idno type="doi">10.1186/1471-2334-14-420</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000A91</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A91</idno><idno type="wicri:Area/Pmc/Curation">000A68</idno><idno type="wicri:explorRef" 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xml:lang="fr">Belgique</country><wicri:regionArea>Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent</wicri:regionArea><placeName><region type="province" nuts="2">Province de Flandre-Orientale</region><settlement type="city">Gand</settlement></placeName></affiliation></author><author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name><affiliation><nlm:aff id="Aff2">Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Butterfield St, Herston, QLD 4029 Australia</nlm:aff><wicri:noCountry code="subfield">QLD 4029 Australia</wicri:noCountry></affiliation></author><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Bachstrasse 18, Jena, D-07743 Germany</nlm:aff><country wicri:rule="zip">Allemagne</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Bachstrasse 18, Jena, D-07743 Germany</wicri:regionArea><wicri:noRegion>07743 Germany</wicri:noRegion><wicri:noRegion>07743 Germany</wicri:noRegion><wicri:noRegion>D-07743 Germany</wicri:noRegion></affiliation></author><author><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C" last="Marshall">John C. Marshall</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, St. Michael's Hospital, 4th Floor Bond Wing, Room 4-007, 30 Bond Street, Toronto, Ontario M5B 1 W8 Canada</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Vanhems, Philippe" sort="Vanhems, Philippe" uniqKey="Vanhems P" first="Philippe" last="Vanhems">Philippe Vanhems</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Pôle Santé, Recherche, Risques et Vigilances, Groupement Hospitalier Edouard Herriot, Service d’Hygiène, Epidémiologie et Prévention, Université Lyon 1, Batiment 1, 5 place d'Arsonval, 69437 Lyon cedex 03, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Pôle Santé, Recherche, Risques et Vigilances, Groupement Hospitalier Edouard Herriot, Service d’Hygiène, Epidémiologie et Prévention, Université Lyon 1, Batiment 1, 5 place d'Arsonval, 69437 Lyon cedex 03</wicri:regionArea><wicri:noRegion>69437 Lyon cedex 03</wicri:noRegion><wicri:noRegion>69437 Lyon cedex 03</wicri:noRegion></affiliation></author><author><name sortKey="Barrera Groba, Casiano" sort="Barrera Groba, Casiano" uniqKey="Barrera Groba C" first="Casiano" last="Barrera Groba">Casiano Barrera Groba</name><affiliation><nlm:aff id="Aff6">Department of Intensive Care, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, East Sussex, Brighton BN2 5BE UK</nlm:aff><wicri:noCountry code="subfield">Brighton BN2 5BE UK</wicri:noCountry></affiliation></author><author><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name><affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Chemin des Bourrely, 13015 Marseille</wicri:regionArea><wicri:noRegion>13015 Marseille</wicri:noRegion><placeName><settlement type="city">Marseille</settlement><region type="région" nuts="2">Provence-Alpes-Côte d'Azur</region></placeName></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><nlm:aff id="Aff8">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement><settlement type="city">Bruxelles</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.</p></sec><sec><title>Methods</title><p>EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.</p></sec><sec><title>Results</title><p>Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 ± 16 years, SAPS II score 39 ± 16, SOFA score 7.6 ± 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for ≤2 days prior to the study day had more <italic>Escherichia coli</italic>, methicillin-sensitive <italic>Staphylococcus aureus</italic> and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer<italic>.</italic> ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality.</p></sec><sec><title>Conclusions</title><p>The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/1471-2334-14-420) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name></author><author><name sortKey="Rello, J" uniqKey="Rello J">J Rello</name></author><author><name sortKey="Marshall, J" uniqKey="Marshall J">J Marshall</name></author><author><name sortKey="Silva, E" uniqKey="Silva E">E Silva</name></author><author><name sortKey="Anzueto, A" uniqKey="Anzueto A">A Anzueto</name></author><author><name sortKey="Martin, Cd" uniqKey="Martin C">CD Martin</name></author><author><name sortKey="Moreno, R" uniqKey="Moreno R">R Moreno</name></author><author><name sortKey="Lipman, J" uniqKey="Lipman 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sortKey="Sandven, P" uniqKey="Sandven P">P Sandven</name></author><author><name sortKey="Qvist, H" uniqKey="Qvist H">H Qvist</name></author><author><name sortKey="Skovlund, E" uniqKey="Skovlund E">E Skovlund</name></author><author><name sortKey="Giercksky, Ke" uniqKey="Giercksky K">KE Giercksky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dupont, H" uniqKey="Dupont H">H Dupont</name></author><author><name sortKey="Bourichon, A" uniqKey="Bourichon A">A Bourichon</name></author><author><name sortKey="Paugam Burtz, C" uniqKey="Paugam Burtz C">C Paugam-Burtz</name></author><author><name sortKey="Mantz, J" uniqKey="Mantz J">J Mantz</name></author><author><name sortKey="Desmonts, Jm" uniqKey="Desmonts J">JM Desmonts</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andes, Dr" uniqKey="Andes D">DR Andes</name></author><author><name sortKey="Safdar, N" uniqKey="Safdar N">N Safdar</name></author><author><name sortKey="Baddley, Jw" uniqKey="Baddley J">JW Baddley</name></author><author><name sortKey="Playford, G" uniqKey="Playford G">G Playford</name></author><author><name sortKey="Reboli, Ac" uniqKey="Reboli A">AC Reboli</name></author><author><name sortKey="Rex, Jh" uniqKey="Rex J">JH Rex</name></author><author><name sortKey="Sobel, Jd" uniqKey="Sobel J">JD Sobel</name></author><author><name sortKey="Pappas, Pg" uniqKey="Pappas P">PG Pappas</name></author><author><name sortKey="Kullberg, Bj" uniqKey="Kullberg B">BJ Kullberg</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Canada</li><li>France</li></country><region><li>Ontario</li><li>Provence-Alpes-Côte d'Azur</li><li>Province de Flandre-Orientale</li><li>Vienne (Autriche)</li></region><settlement><li>Bruxelles</li><li>Gand</li><li>Marseille</li><li>Toronto</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université de Toronto</li><li>Université libre de Bruxelles</li></orgName></list><tree><noCountry><name sortKey="Barrera Groba, Casiano" sort="Barrera Groba, Casiano" uniqKey="Barrera Groba C" first="Casiano" last="Barrera Groba">Casiano Barrera Groba</name><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name></noCountry><country name="Belgique"><region name="Province de Flandre-Orientale"><name sortKey="De Waele, Jan" sort="De Waele, Jan" uniqKey="De Waele J" first="Jan" last="De Waele">Jan De Waele</name></region><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></country><country name="Allemagne"><noRegion><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name></noRegion></country><country name="Canada"><region name="Ontario"><name sortKey="Marshall, John C" sort="Marshall, John C" uniqKey="Marshall J" first="John C" last="Marshall">John C. Marshall</name></region></country><country name="France"><noRegion><name sortKey="Vanhems, Philippe" sort="Vanhems, Philippe" uniqKey="Vanhems P" first="Philippe" last="Vanhems">Philippe Vanhems</name></noRegion><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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