TY - JOUR
T1 - Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units
AU - Vogelaers, Dirk
AU - Blot, Stijn
AU - Van den Berge, Andries
AU - Montravers, Philippe
AU - for the Abdominal Sepsis Study (‘AbSeS’) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine
A2 - Francois, Guy
A2 - Labeau, Sonia
A2 - Blot, Koen
A2 - Deschepper, Mieke
A2 - Antonelli, Massimo
A2 - Lipman, Jeffrey
A2 - Lamrous, Amin
A2 - Pereyra, Cecilia
A2 - Lipovestky, Fernando
A2 - Koulenti, Despoina
A2 - De Waele, Jan
A2 - Rezende-Neto, Joao
A2 - Cardenas, Yenny
A2 - Vymazal, Tomas
A2 - Fjeldsoee-Nielsen, Hans
A2 - Kott, Matthias
A2 - Kostoula, Arvaniti
A2 - Javeri, Yash
A2 - Girardis, Massimo
A2 - Einav, Sharon
A2 - de Lange, Dylan
A2 - Makikado, Luis Daniel Umezawa
A2 - Mikstacki, Adam
A2 - Paiva, José Artur
A2 - Tomescu, Dana
A2 - Gritsan, Alexey
A2 - Jovanovic, Bojan
A2 - Venkatesan, Kumaresh
A2 - Mirkovic, Tomislav
A2 - Maseda, Emilio
A2 - Dikmen, Yalim
A2 - Creagh-Brown, Benedict
A2 - Lamrous, Amin
A2 - Emmerich, Monica
A2 - Canale, Mariana
A2 - Dietz, Lorena Silvina
A2 - Ilutovich, Santiago
A2 - Miñope, John Thomas Sanchez
A2 - Silva, Ramona Baldomera
A2 - Montenegro, Martin Alexis
A2 - Martin, Patricio
A2 - Saul, Pablo
A2 - Chediack, Viviana
A2 - Sutton, Giselle
A2 - Couce, Rocio
A2 - Nielsen, Louise Gramstrup
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
PY - 2021/5/26
Y1 - 2021/5/26
N2 - 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.
AB - 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.
U2 - 10.1007/s40265-021-01534-w
DO - 10.1007/s40265-021-01534-w
M3 - Journal article
C2 - 34037963
AN - SCOPUS:85106535833
VL - 81
SP - 1065
EP - 1078
JO - Drugs
JF - Drugs
SN - 0012-6667
IS - 9
ER -