Maseda, EmilioRamírez, SofíaPicatto, PedroPeláez Peláez, EvaGarcía Bernedo, CarlosOjeda Betancur, NazarioAguilar, GerardoForés, BeatrizSolera Marín, JorgeGiménez Mestre, María JoséEt al.2022-02-042022-02-042019Maseda, E, Ramírez, S., Picatto, P., Peláez-Peláez, E., García-Bernedo, C., Ojeda-Betancur, N., Aguilar, G., Foré, B., Solera-Marín, J., Aliaño-Piña, M., Tamayo, E., Ramasco, F., García-Álvarez, R., González-Lisorge, A., Giménez, M.-J., & Suárez de la Rica, A. (2019). Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality. PLos One, 14(9), e0223092. https://doi.org/10.1371/journal.pone.02230921932-6203http://hdl.handle.net/11268/10686The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non-postoperative/non-nosocomial) in patients admitted to intensive care units (ICUs), to investigate differences in resistance patterns linked to healthcare exposure and mortality-associated factors. A one-year prospective observational study (17 Spanish ICUs) was performed distributing cases as healthcare-associated infections (HCAI), community-acquired infections (CAI) and immunocompromised patients (ICP). Bacteria producing extended-spectrum β-lactamases (ESBL) and/or carbapenemase (CPE), high-level aminoglycoside- and/or methicillin- and/or vancomycin- resistance were considered antimicrobial resistant (AMR). Mortality-associated factors were identified by regression multivariate analysis. Of 345 patients included (18.8% HCAI, 6.1% ICP, 75.1% CAI), 51.6% presented generalized peritonitis; 32.5% were >75 years (55.4% among HCAI). Overall, 11.0% cases presented AMR (7.0% ESBL- and/or CPE), being significantly higher in HCAI (35.4%) vs. CAI (5.8%) (p<0.001) vs. ICP (0%) (p = 0.003). Overall 30-day mortality was 14.5%: 23.1% for HCAI and 11.6% for CAI (p = 0.016). Mortality (R2 = 0.262, p = 0.021) was positively associated with age >75 years (OR = 6.67, 95%CI = 2.56-17.36,p<0.001), Candida isolation (OR = 3.05, 95%CI = 1.18-7.87,p = 0.022), and SAPS II (per-point, OR = 1.08, 95%CI = 1.05-1.11, p<0.001) and negatively with biliary infections (OR = 0.06, 95%CI = 0.01-0.48,p = 0.008). In this study, the antimicrobial susceptibility pattern of bacteria isolated from patients with healthcare contact was shifted to resistance, suggesting the need for consideration of the healthcare category (not including hospital-acquired infections) for severe IAIs. 30-day mortality was positively related with age >75 years, severity and Candida isolation but not with AMR.engAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Infección hospitalariaInvestigación sobre servicios de saludMortalidad hospitalariajournal article10.1371/journal.pone.0223092open accessAnálisis de datosHospitalMortalidad