Open Access Highly Accessed Research article

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

Jan De Waele1*, Jeffrey Lipman2, Yasser Sakr3, John C Marshall4, Philippe Vanhems5, Casiano Barrera Groba6, Marc Leone7, Jean-Louis Vincent8 and for the EPIC II Investigators

Author Affiliations

1 Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium

2 Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Butterfield St, Herston, QLD 4029, Australia

3 Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Bachstrasse 18, Jena D-07743, Germany

4 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

5 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

6 Department of Intensive Care, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, East Sussex, Brighton BN2 5BE, UK

7 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

8 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium

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BMC Infectious Diseases 2014, 14:420  doi:10.1186/1471-2334-14-420

Published: 29 July 2014

Abstract

Background

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.

Methods

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.

Results

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 Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. 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.

Conclusions

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.

Keywords:
Abdominal infection; Abscess; Peritonitis; Severe sepsis; Critical care; Antibiotic therapy; Microbiology