Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit

Kévin Boussion,Grégory Papin,Nathalie Grall,Nathalie Zappella,Lara Ribeiro-Parenti,Philippe Montravers

doi:10.1038/s41598-021-85443-8

Abstract

The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.

Highlights

The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated
380 patients were admitted to our intensive care units (ICU) for the diagnosis of HAI, including 87 (23%) patients with positive staphylococci cultures of the peritoneal fluid
At the time of reoperation for HAI, a gastroduodenal source of infection was more frequent in patients with staphylococci, while these patients had a lower SOFA score than nS-HAI patients (Table 1)

Summary

Introduction

The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Staphylococci are identified as frequent nosocomial pathogens in intensive care units (ICU)[1,2] These microorganisms are responsible for invasive infections, including bacteremia, pneumonia, and postoperative infections. The objective of this study was to compare the epidemiological, clinical, microbiological and prognostic characteristics of patients admitted to the ICU for hospital-acquired postoperative intra-abdominal infections (HAIs) according to the presence or absence of staphylococci in their peritoneal cultures. The respective portions of S. aureus and CoNS were evaluated in terms of clinical presentation, therapeutic consequences and outcome

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