Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units.
Dirk VogelaersStijn I BlotAndries Van den BergePhilippe Montraversnull nullPublished in: Drugs (2021)
Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent 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 profiles 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, fluoroquinolones, 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.
Keyphrases
- intensive care unit
- escherichia coli
- klebsiella pneumoniae
- late onset
- staphylococcus aureus
- antimicrobial resistance
- pseudomonas aeruginosa
- septic shock
- healthcare
- early onset
- mechanical ventilation
- multidrug resistant
- acinetobacter baumannii
- biofilm formation
- risk factors
- south africa
- end stage renal disease
- cystic fibrosis
- emergency department
- ejection fraction
- gram negative
- mesenchymal stem cells
- prognostic factors
- acute kidney injury
- peritoneal dialysis
- electronic health record
- patient reported outcomes