Introduction
Study design
Results
Patients
Clinical findings | Patients |
---|---|
n° (%) | |
Abdominal pain | 271 (12.6) |
Abdominal pain, abdominal rigidity | 192 (8.9%) |
Abdominal pain, abdominal rigidità, T>38°C or <36°C, WBC >12,000 or < 4,000 | 366 (17%) |
Abdominal pain, abdominal rigidity, T>38°C or <36°C, | 70 (3.2) |
Abdominal pain, abdominal rigidity, WBC >12,000 or < 4,000 | 445 (20.7%) |
Abdominal pain, T>38°C or <36°C, | 71 (3.3%) |
Abdominal pain, T>38°C or <36°C, WBC >12,000 or < 4,000 | 235 (10.9%) |
Abdominal pain, WBC >12,000 or < 4,000 | 325 (15.1) |
T>38°C or <36°C | 15 (0.7 %) |
T>38°C or <36°C, WBC >12,000 or < 4,000 | 45 (2.0%) |
Abdominal rigidity, WBC >12,000 or < 4,000 | 15 (0.7%) |
Abdominal rigidity | 15 (0.7%) |
Abdominal rigidity, T>38°C or <36°C | 22 (1%) |
WBC >12,000 or < 4,000 | 32 (1.5%) |
Not reported | 33 (1.5%) |
Radiological procedures | Patients |
---|---|
n° (%) | |
Abdomen X ray | 198 (9.2%) |
Abdomen X ray, CT | 164 (7.6%) |
Abdomen X ray, ultrasound | 401(18.6%) |
Abdomen X ray, ultrasound, CT | 205 (9.5%) |
Abdomen X ray, ultrasound, MRI | 3 (0.1%) |
CT | 527 (24.5%) |
Ultrasound | 345 (16.0%) |
Ultrasound, CT | 160 (8.3%) |
Ultrasound, CT, MRI | 5 (0.2%) |
Ultrasound, MRI | 6 (0.3%) |
Not reported | 131 (6%) |
Source control
Source of infection | Patients |
---|---|
N 2152° (100%) | |
Appendicitis | 798 (37%) |
Cholecystitis | 289 (13.4%) |
Post-operative | 342 (15.,9%) |
Colonic non diverticular perforation | 158 (7.3%) |
Gastroduodenal perforations | 156 (7.3%) |
Diverticulitis | 166 (7.7%) |
Small bowel perforation | 103 (4.8%) |
Others | 110 (5.1%) |
PID | 18 (0.8%) |
Post traumatic perforation | 12 (0.6%) |
Microbiology
Total | 1,525 (100%) |
---|---|
Aerobic Gram-negative bacteria
|
1,041 (69.2%)
|
Escherichia coli | 632 (41.4%) |
(Escherichia coli resistant to third generation cephalosporins) | 64 (4.2%) |
Klebsiella pneuumoniae | 109 (7.1%) |
(Klebsiella pneumoniae resistant to third generation cephalosporins) | 37 (2.4%) |
Enterobacter | 63 (4.1%) |
Proteus | 33 (2.1 %) |
Pseudomonas | 80 (5.2%) |
Others | 124 (8.1%) |
Aerobic Gram-positive bacteria
|
484 (31.7%)
|
Enterococcus faecalis | 169 (11%) |
Enterococcus faecium | 72 (4.7%) |
Staphylococcus Aureus | 56 (3.7%) |
Streptococcus spp. | 100 (6,6%) |
Others | 87 (5.7%) |
Community-acquired IAIs | Isolates | Healthcare-associated (nosocomial) IAIs | Isolates |
---|---|---|---|
n° | n° | ||
Aerobic bacteria | 988 (100%) | Aerobic bacteria | 567 (100%) |
Escherichia coli | 480 (48.6%) | Escherichia coli | 152 (26.8%) |
(Escherichia coli resistant to third generation cephalosporins) | 30 (3%) | (Escherichia coli resistant to third generation cephalosporins) | 34 (6%) |
Klebsiella pneumoniae | 52 (5.2%) | Klebsiella pneumoniae | 57 (10%) |
(Klebsiella pneumoniae resistant to third generation cephalosporins) | 11 (1,7%) | (Klebsiella pneumoniae resistant to third generation cephalosporins) | 22 (6.7%) |
Pseudomonas | 42 (4.2%) | Pseudomonas | 38 (6.7%) |
Enterococcus faecalis | 78 (7.9%) | Enterococcus faecalis | 91 (16%) |
Enterococcus faecium | 39 (3.9%) | Enterococcus faecium | 43 (7.6%) |
Anaerobes | 197 |
---|---|
Bacteroides | 126 (64%) |
(Bacteroides resistant to Metronidazole) | 4 (2%) |
Clostridium | 16 (8.1%) |
(Clostridium resistant to Metronidazole) | 1 (0.5%) |
Others | 55 (27.9%) |
Candida | 138 |
---|---|
Candida albicans | 110 (79.7%) |
(Candida albicans resistant to Fluconazole) | 4 (2.9%) |
Non-albicans Candida | 28 (20.3%) |
(non-albicans Candida resistant to Fluconazole) | 5 (3.6%) |
Outcome
Risk factors | Odds ratio | 95%CI | p |
---|---|---|---|
Clinical condition upon hospital admission
| |||
Severe sepsis | 27.6 | 15.9-47.8 | <0.0001 |
Septic shock | 14.6 | 8.7-24.4 | <0.0001 |
Healthcare associated infection
| |||
Chronic care setting acquired | 5.2 | 1.7-8.4 | <0.0001 |
Non post-operative hospital acquired | 3.8 | 2.4-10.9 | <0.0001 |
Post-operative | 2.5 | 1.7-3.7 | <0.0001 |
Source of infection
| |||
Colonic non diverticular perforation | 117.4 | 27.9-493.9 | <0.0001 |
Diverticulitis | 45.4 | 10.4-198.6 | <0.0001 |
Small bowel perforation | 125.7 | 29.1-542 | <0.0001 |
Delayed initial intervention | 2.6 | 1.8-3.5 | <0.0001 |
Immediate post-operative clinical course
| |||
Severe sepsis | 33.8 | 19.5-58.4 | <0.0001 |
Septic shock | 59.2 | 34.4-102.1 | <0.0001 |
ICU admission | 18.6 | 12-28.7 | <0.0001 |
WBC>12000 or <4000 (3nd post-operative day) | 2.8 | 1.8-4.4 | <0.0001 |
T>38°C or <36°C (3nd post-operative day) | 3.3 | 2.2-5 | <0.0001 |
Risk factors | Odds ratio | 95%CI | p |
---|---|---|---|
Age | 3.3 | 2.2-5 | <0.0001 |
Severe sepsis in the immediate post-operative course | 27.6 | 15.9-47.8 | <0.0001 |
Septic shock in the immediate post-operative course | 14.6 | 8.7-24.4 | <0.0001 |
Colonic non diverticular perforation | 4.7 | 2.5-8 | <0.0001 |
Diverticulitis | 2.3 | 1.5-3.7 | <0.0001 |
Small bowel perforation | 21.4 | 8-57.4 | <0.0001 |
Delayed initial intervention | 2.4 | 1.5-3.7 | 0.0001 |