PLoS ONE (Jan 2019)

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

  • Emilio Maseda,
  • Sofía Ramírez,
  • Pedro Picatto,
  • Eva Peláez-Peláez,
  • Carlos García-Bernedo,
  • Nazario Ojeda-Betancur,
  • Gerardo Aguilar,
  • Beatriz Forés,
  • Jorge Solera-Marín,
  • María Aliaño-Piña,
  • Eduardo Tamayo,
  • Fernando Ramasco,
  • Raquel García-Álvarez,
  • Ada González-Lisorge,
  • María-José Giménez,
  • Alejandro Suárez-de-la-Rica,
  • HELP Investigators and the Perioperative Infection Research Group

DOI
https://doi.org/10.1371/journal.pone.0223092
Journal volume & issue
Vol. 14, no. 9
p. e0223092

Abstract

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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%) (p75 years (OR = 6.67, 95%CI = 2.56-17.36,p75 years, severity and Candida isolation but not with AMR.