Complicated intra-abdominal infections (cIAI) extend beyond a hollow viscus into the peritoneal space, because of the disruption of anatomic barriers. The objectives of this study are to evaluate the prognostic factors of cIAI in the intensive care unit (ICU) and to provide an update on the current micro-organisms isolated and their resistance.
We conducted a retrospective study and included 34 consecutive patients with secondary or tertiary peritonitis, admitted to the ICU from July 2005 to December 2008.
Perforated gastrointestinal tract was the etiology of sepsis in 26 (76.5%) patients. Lower gastrointestinal tract was the source in most (28; 82%) of the patients. Intra-abdominal cultures were obtained from 22 (65%) patients only. 16 (76.2%) of these patients had positive intra-abdominal cultures, with multiple organisms in 12 (75%) of these patients. The organisms isolated were anaerobes (11), gram negative bacilli (9), staphylococcus epidermidis (3), staphylococcus aureus (1), streptococcus viridians (7), enterococcus fecalis (1), corynebacterium (1) and candida albicans (2). Half the patients with intra-abdominal cultures grew organisms resistant to one or more antibiotics. Bacteremia was seen in only 2 (5.8%) of the patients. Antibiotics were escalated in 13 (38%) patients based on the cultures or clinical deterioration. Surgical interventions were performed in 31 cases (91%), with 4 (11.8%) cases requiring repeated interventions. 3 patients died with the mortality rate of 8.8%. Mean ICU length of stay was 4.4 (+/− 5.1) days. Univariate regression analysis showed that the ICU length of stay was significantly associated with the duration of mechanical ventilation, number of antibiotics, number of vasopressors and duration of total parenteral nutrition. None of these co-variates were significant on multivariate analysis.
In our case series, half the patients with intra-abdominal cultures had resistant organisms and antimicrobial therapy needed to be escalated in a significant number of patients.
New clinical studies are warranted to evaluate increasing resistance in micro-organisms responsible for complicated intra-abdominal infections.
Kamran Mahmood, No Financial Disclosure Information; No Product/Research Disclosure Information