Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Massimo Sartelli,Jakub Kenig,Goran Augustin,Sergio Aloia,Harry Van Goor,Vladimir Khokha,Daniel Lazzareschi,Roberto Bini,Ferdinando Agresta,Ihor Gerych,Saila Kauhanen,Elio Jovine,Nereo Vettoretto,Samipetteri Laine,Carlo De Werra,Dimitrios Giakoustidis,Olivier Pittet,Daniele Marrelli,Mario Dente,Pieter Pletinckx,Ludwig Ney,Pierluigi Viale,Fausto Catena,Luca Ansaloni,Boris Sakakushev,Piotr Major,Konstantinos Lasithiotakis,Marco Catani,Cyrille Huchon,Charalampos Seretis,Mirjami Uotila-Nieminen,Rodolfo Scibé,Eliane Angst,Salvador Navarro,Elia Poiasina,Damien Massalou,Tadeja Pintar,Athanasios Marinis,Dmitry Smirnov,Stefano Rausei,Orestis Ioannidis,Miran Rems,Jaan Tepp,Giorgio Vasquez,Giorgio Giraudo,Konstantinos Bouliaris,Cristian Tranà,Gianluca Guercioni,Avdyl Krasniqi,Salomone Di Saverio,Adam Dziki,Helen Tzerbinis,Michele Cucchi,S Colizza ,Halil Alış ,Cristian Meşină ,András Vereczkei ,Renato Bessa Melo ,Pietro Coletta,Miguel León ,Korhan Taviloğlu ,Nurkan Törer ,Nikola Vladov,Rafael Díaz-Nieto ,Dragoljub Živanović ,R Moldovanu ,M Hut'an ,Ionuţ Negoi ,Jorge Pereira,Samir Delibegović ,Fabio Cesare Campanile ,M Škrovina ,Guenter Weiss,Ari Leppäniemi

doi:10.1186/1749-7922-7-15

Abstract

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4–98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Highlights

Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis.From a clinical perspective, intra-abdominal infections (IAIs) are classified in two major categories: complicated and uncomplicated [1].In the event of a complicated IAI, the infectious process proceeds beyond a singularly affected organ and causes either localized peritonitis or diffuse peritonitis
Study design The purpose of the CIAO Study is to describe the epidemiological, clinical, microbiological, and treatment profiles of community-acquired and healthcare-associated complicated intra-abdominal infections (IAIs) based on the data collected over a six-month period (January 2012 to June 2012) from 66 medical institutions across Europe
Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor clinical prognoses, for patients in highrisk categories

Summary

Introduction

Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis.From a clinical perspective, IAIs are classified in two major categories: complicated and uncomplicated [1].In the event of a complicated IAI, the infectious process proceeds beyond a singularly affected organ and causes either localized peritonitis (intra-abdominal abscesses) or diffuse peritonitis. Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis. IAIs are classified in two major categories: complicated and uncomplicated [1]. In the event of a complicated IAI, the infectious process proceeds beyond a singularly affected organ and causes either localized peritonitis (intra-abdominal abscesses) or diffuse peritonitis. Treating patients with complicated intra-abdominal infections involves both source control and antibiotic therapy. Source control is a broad term encompassing all measures undertaken to eliminate the source of infection and control ongoing contamination [2]. The most common source of infection in communityacquired intra-abdominal infections is the appendix, followed by the colon, and the stomach. Dehiscence complicates 5–10% of intra-abdominal bowel anastomoses and is associated with an increased mortality rate [3]

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