Enterococci increase the morbidity and mortality associated with severe intra-abdominal infections in elderly patients hospitalized in the intensive care unit

Dupont, Hervé; Friggeri, Arnaud; Touzeau, Jérémy; Airapetian, Norair; Tinturier, F.; Lobjoie, E; Lorne, Emmanuel; Hijazi, May; Régimbeau, Jean‐Marc; Mahjoub, Yazine

doi:10.1093/jac/dkr308

Cited by 70 publications

(39 citation statements)

References 42 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Approximately 300,000 cases of appendicitis occur each year in the United States, 1 and at least twice that many cases of non-appendiceal infection require management. 2 Morbidity ranges from 5% among patients evaluated in broad observational studies 2–4 to close to 50% in some cohorts, such as the elderly or critically ill. 5,6 Despite the diversity of specific processes in these infections, the basic tenets of management are similar: resuscitate patients who have the systemic inflammatory response syndrome (SIRS), control the source of contamination, remove most of the infected or necrotic material, and administer antimicrobial agents to eradicate residual pathogens. 7,8 …”

mentioning

confidence: 99%

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

View full text Add to dashboard Cite

BACKGROUND The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P = 0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

show abstract

mentioning

confidence: 99%

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Although outcomes may have improved over the years [15], abdominal infections still carry a significant mortality risk. Isolation of nosocomial microorganisms [16], enterococci [17] or fungi [18, 19] is often cited as contributing to mortality, but the extent to which these organisms contribute to that risk is unknown. The role of comorbidities as well as demographic characteristics has also not been studied on a large scale.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

View full text Add to dashboard Cite

BackgroundAbdominal 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.MethodsEPIC 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.ResultsOf 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-420) contains supplementary material, which is available to authorized users.

show abstract

“…Although Enterococci were also present in community-acquired infections, they were more prevalent in HA-IAIs (22.3% in HA-IAIs versus 13.9% in CA-IAIs). Some studies have demonstrated poor outcomes among patients with documented enterococcal infections [185][186][187][188], particularly in those with post-operative IAIs where Enterococci coverage should always be considered. Empirical coverage of Enterococci is not generally recommended for patients with CA-IAIs.…”

Section: Statement 31mentioning

confidence: 99%

Management of Intra-Abdominal Infections

Moore

2016

Common Problems in Acute Care Surgery

View full text Add to dashboard Cite

This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

show abstract

Enterococci increase the morbidity and mortality associated with severe intra-abdominal infections in elderly patients hospitalized in the intensive care unit

Abstract: In severely ill, elderly patients in the ICU for an IAI, the isolation of enterococci was associated with increased disease severity and morbidity and was an independent risk factor for mortality.

Cited by 70 publications

References 42 publications

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

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

Management of Intra-Abdominal Infections

Contact Info

Product

Resources

About