Outcome of community- versus hospital-acquired intra-abdominal infections in intensive care unit: a retrospective study
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RESEARCH ARTICLE
Open Access
Outcome of community- versus hospitalacquired intra-abdominal infections in intensive care unit: a retrospective study Timothée Abaziou1* , Fanny Vardon-Bounes1, Jean-Marie Conil1, Antoine Rouget1, Stéphanie Ruiz1, Marion Grare2, Olivier Fourcade1, Bertrand Suc3, Marc Leone4, Vincent Minville1 and Bernard Georges1
Abstract Background: To compare patients hospitalised in the intensive care unit (ICU) after surgery for communityacquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications. Methods: Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis. Results: Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p < 0.001 and 41 [24–66] vs. 17 [7–32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI. Conclusion: CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications. Keywords: Intra-abdominal infection, Peritonitis, Outcome, Microbiology, Intensive care unit
Background In some studies, the mortality of patients developing severe intra-abdominal infection (IAI) reaches 50% [1–3]. Among severe intra-abdominal infections, peritonitis is classified according to one of 3 categories: primary, with a medical aetiology and treatment; secondary, of surgical origin representing the most prevalent cases; and tertiary, with an ongoing intra-abdominal infection despite appropriate care [2] . In the case of secondary peritonitis, * Correspondence: [email protected] 1 Département D’Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059 Toulouse, France Full list of author information is available at the end of the article
treatment is surgical, requiring peritoneal washing after bacteriological sampling, and repair of gut lesions, associated with antibiotics and support for organ failure [2, 4]. Two types of IAI are defined: community-acquired IAI (CA-IAI) and hospital-acquired (HA-IAI) [3]. CA-IAI has a florid presentation, with fever and peritoneal signs. Escherichia coli (E. coli) is the most frequently found bacteria [5–7]. In contrast, peritoneal signs are less apparent in patients with HA-IAI. Although E. coli is still the most frequent bacteria, antimicrobial resistance is common
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