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

• Published in: PloS one Vol. 14; no. 9; p. e0223092
• Main Authors: Maseda, Emilio, Ramírez, Sofía, Picatto, Pedro, Peláez-Peláez, Eva, García-Bernedo, Carlos, Ojeda-Betancur, Nazario, Aguilar, Gerardo, Forés, Beatriz, Solera-Marín, Jorge, Aliaño-Piña, María, Tamayo, Eduardo, Ramasco, Fernando, García-Álvarez, Raquel, González-Lisorge, Ada, Giménez, María-José, Suárez-de-la-Rica, Alejandro
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.09.2019; Public Library of Science (PLoS)
• Subjects: Abdomen; Adult; Age Factors; Aged; Aged, 80 and over; Aminoglycosides; Anesthesiology; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Bacteria; Bacteria - drug effects; Bacteria - isolation & purification; Biology and Life Sciences; Candida; Carbapenemase; Communities; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Community-Acquired Infections - mortality; Critical care; Critical Illness - mortality; Critical Illness - therapy; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - mortality; Drug Resistance, Bacterial; Epidemiology; Exposure; Female; Health care; Hospitals; Humans; Immunocompromised hosts; Infections; Intensive care; Intensive care units; Intensive Care Units - statistics & numerical data; Intraabdominal Infections - diagnosis; Intraabdominal Infections - drug therapy; Intraabdominal Infections - microbiology; Intraabdominal Infections - mortality; Male; Medicine and Health Sciences; Methicillin; Middle Aged; Mortality; Multivariate analysis; Nosocomial infection; Nosocomial infections; Peritonitis; Prospective Studies; Regression analysis; Resistance factors; Risk Factors; Sepsis; Severity of Illness Index; Spain - epidemiology; Vancomycin; Spain; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0223092

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.