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      Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

      research-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 1 , 3 , 8 , 9 , 10 , 11 , 1 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 3 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ,   52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 9 , 66 , 67 , 68 , 69 , 70 , 2 , 71 , 72 , 72
      World Journal of Emergency Surgery : WJES
      BioMed Central

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          Abstract

          The CIAO Study (“ Complicated Intra-Abdominal infection Observational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).

          Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.

          2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.

          The overall mortality rate was 7.5% (163/2.152).

          According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.

          Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

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          Most cited references14

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          The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria.

          From early this decade, Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases (KPC) were reported in the USA and subsequently worldwide. These KPC-producing bacteria are predominantly involved in nosocomial and systemic infections; although they are mostly Enterobacteriaceae, they can also be, rarely, Pseudomonas aeruginosa isolates. KPC beta lactamases (KPC-1 to KPC-7) confer decreased susceptibility or resistance to virtually all beta lactams. Carbapenems (imipenem, meropenem, and ertapenem) may thus become inefficient for treating enterobacterial infections with KPC-producing bacteria, which are, in addition, resistant to many other non-beta-lactam molecules, leaving few available therapeutic options. Detection of KPC-producing bacteria may be difficult based on routine antibiotic susceptibility testing. It is therefore crucial to implement efficient infection control measures to limit the spread of these pathogens.
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            A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients.

            Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures. We analyzed the results of epidemiologic studies of infection caused by ESBL-producing Enterobacteriaceae in nonhospitalized patients from 6 centers in Europe, Asia, and North America. Risk factors for infection with an ESBL-producing organism were identified by univariate and multivariate analyses. A total of 983 patient-specific isolates were reviewed (890 [90.5%] of which were Escherichia coli, 68 [6.9%] of which were Klebsiella species, and 25 [2.5%] of which were Proteus mirabilis); 339 [34.5%] of the isolates produced ESBLs. CTX-M types were the most frequent ESBLs (accounting for 65%). Rates of co-resistance to ciprofloxacin among ESBL-producing isolates were high (>70%), but significant variation was seen among centers with respect to rates of resistance to gentamicin, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Similar risk factors for infection with an ESBL-producing organism were found in the different participating centers. Significant risk factors, identified by multivariate analysis, were recent antibiotic use, residence in a long-term care facility, recent hospitalization, age 65 years, and male sex (area under the receiver-operator characteristic [ROC] curve, 0.80). However, 34% of ESBL-producing isolates (115 of 336 isolates) were obtained from patients with no recent health care contact; the area under the ROC curve for the multivariate model for this group of patients was only 0.70, which indicated poorer predictive value. Community-acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration. Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control.
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              Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review.

              This systematic literature review was designed to summarize and compare the reported outcomes of one-stage and two-stage operations for the treatment of perforated diverticulitis with peritonitis. This review identified 98 published studies (1957-2003) dealing with the surgical management of perforated diverticulitis with peritonitis, either with primary resection and anastomosis or with the Hartmann's procedure. Aggregated results of adverse outcomes were calculated but statistical comparisons were not appropriate because of data and design heterogeneity. Operative mortality data from patients with diverticular peritonitis undergoing Hartmann's procedure (n = 1,051) were derived from 54 studies. Considering the Hartmann's procedure and its reversal procedures together, the mortality rate was 19.6 percent (18.8 percent for the Hartmann's procedure and 0.8 percent for its reversal), the wound infection rate was 29.1 percent (24.2 percent for the Hartmann's procedure and 4.9 percent for its reversal), and stoma complications and anastomotic leaks (in the reversal operation) occurred in 10.3 and 4.3 percent, respectively. Of 569 reported cases of primary anastomosis from 50 studies, the aggregated mortality rate was 9.9 (range, 0-75) percent with an anastomotic leak rate of 13.9 (range, 0-60) percent and a wound infection rate of 9.6 (range, 0-26) percent. Reported mortality and morbidity in patients with diverticular peritonitis who underwent primary anastomosis were not higher than those in patients undergoing Hartmann's procedure were. This suggests that primary anastomosis is a safe operative alternative in certain patients with peritonitis. Despite inclusion of only patients with peritonitis in this analysis, selection bias may have been a limitation and a prospective, randomized trial is recommended.
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                Author and article information

                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central
                1749-7922
                2012
                29 November 2012
                : 7
                : 36
                Affiliations
                [1 ]Department of Surgery, Macerata Hospital, Macerata, Italy
                [2 ]Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
                [3 ]Department of General Surgery, Ospedali Riuniti, Bergamo, Italy
                [4 ]Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
                [5 ]Department of Surgery, Sisli Florence Nigtingale Hospital, Istanbul, Turkey
                [6 ]Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
                [7 ]Department of Internal Medicine Geriatrics and Nephrologic Diseases, Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
                [8 ]Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy
                [9 ]General, Oncological, Geriatrical Surgery and advanced Technology, University Federico II, Naples, Italy
                [10 ]Department of Human Pathology and Oncology, Policlinico le Scotte, University Hospital, Siena, Italy
                [11 ]Department of Surgery, Fatebenefratelli Isola Tiberina hospital, Rome, Italy
                [12 ]Department of General Surgery, Bakirkoy Training Research Hospital, Istanbul, Turkey
                [13 ]Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
                [14 ]Department of Surgery, Parc Tauli University Hospital, Barcelona, Spain
                [15 ]First General Surgery Clinic, University Hospital St. George/Chair of Surgical Propedeutics, Medical Faculty, Medical University Plovdiv, Plovdic, Bulgaria
                [16 ]Department of Emergency Surgery, University Hospital of Nice, University of Nice Sophia-Antipolis, Sophia-Antipolis, France
                [17 ]Department of Surgery, University Hospital Center, Zagreb, Croatia
                [18 ]Emergency Department, Umberto I Hospital, “La Sapienza” University of Rome, Rome, Italy
                [19 ]Department of Gastroenterological surgery Turku, University Central Hospital, Turku, Finland
                [20 ]Department of Surgery, AZ Maria Middelares, Ghent, Belgium
                [21 ]3rd Department of Generał Surgery, Narutowicz Hospital, Krakow, Połand
                [22 ]Department of Surgery, Maggiore Hospital, Bologna, Italy
                [23 ]Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy
                [24 ]Department of Surgery Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech republic
                [25 ]Department of General and Digestive Surgery, Virgen de la Victoria University Hospital, Malaga, Spain
                [26 ]Department of Surgery, Mauriziano Hospital, Torino, Italy
                [27 ]Department of Surgery (Chief Renzo Dionigi), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
                [28 ]Department GI-surgery, Kuopio University Hospital, Kuopio, Finland
                [29 ]2nd Department of Surgery, Jagiellonian University, Krakow, Poland
                [30 ]Department of Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland
                [31 ]Department of Visceral Surgery Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland
                [32 ]Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine
                [33 ]Department of General Surgery, Ospedale Civile, Adria (RO), Italy
                [34 ]General and Vascular Surgery, M.Mellini Hospital, Chiari, Italy
                [35 ]First General Surgery, North Estonia Regional Hospital, Tallinn, Estonia
                [36 ]Intensive Care Klinikum, Magdeburg gGmbH, Magdeburg, Germany
                [37 ]Department of Emergency Surgery Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
                [38 ]Department of Hepato-biliary and Pancreatic surgery and Transplantology, Military Medical Hospital, Sofia, Bulgaria
                [39 ]Department of Surgery, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
                [40 ]Department of surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina
                [41 ]Department of General and Colorectal Surgery, University Hospital, Central Veterans Hospital, Lodz, Poland
                [42 ]Surgical Department Santa Croce e Carle hospital, Cuneo, Italy
                [43 ]Department of Surgery, São Teotónio Hospital, Viseu, Portugal
                [44 ]Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom
                [45 ]Department of Surgery, Manchester Royal Infirmare, Manchester, UK
                [46 ]IInd Surgical department of Medical faculty Comenius University, University Hospital Bratislava, st. Cyril and Methodius Hospital, Bratislava, Slovakia
                [47 ]Department of Surgery, Medical School University of Pécs, Pécs, Hungary
                [48 ]Department of Abdominal Surgery, University Clinical Centre of Kosovo, Prishtina, Kosovo
                [49 ]2nd Department of Surgery, General Army Hospital of Athens, Athens, Greece
                [50 ]Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Roumanie
                [51 ]Surgical Department, General hospital Jesenice, Jesenice, Slovenia
                [52 ]Department of surgery, Andosilla Hospital, Civita Castellana, Italy
                [53 ]Department of Surgery, Jesi Hospital, Jesi, Italy
                [54 ]Department of Gastrointestinal Surgery, North Carelian Central Hospital, Joensuu, Finland
                [55 ]Oncologic, Digestive and Emergency Surgery, Bocage Hospital, Dijon, France
                [56 ]Surgical Department General Hospital of Larissa, Larissa, Greece
                [57 ]Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece
                [58 ]Surgical Department, Mozyr, Belarus
                [59 ]Department of Pediatric surgery, Paediatric surgery and orthopaedic Clinic, Nis, Serbia
                [60 ]General Surgery, Clinical Hospital at Chelyabinsk Station OJSC "Russian Railroads", Chelyabinsk City, Russian Federation
                [61 ]First Department of Surgery, Tzanion General Hospital, Piraeus, Greece
                [62 ]Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
                [63 ]Deparment of Surgery, Downtown Campus, University Hospital of Munich, Munich, Germany
                [64 ]General and emergency surgery, SG Bosco Hospital, Torino, Italy
                [65 ]Department of General Surgery, Hospital La Paz, Madrid, Spain
                [66 ]Department of Gynecology and Obstetrics, CHI Poissy-St-Germain-En-Laye, France and University Versailles Saint-Quentin, Versailles, France
                [67 ]Chirurgie Viscerale, Digestive et Oncologique Hospital Prive, Arras les Bonnettes, Arras, France
                [68 ]Department of General Surgery, Hospital São João Porto, Porto, Portugal
                [69 ]Division of Transplantation, Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
                [70 ]1st Surgical Department, General Regional Hospital "George Papanikolaou", Thessaloniki, Greece
                [71 ]Department of Abdominal Surgery, umc Ljubljana, Ljubljana, Slovenia
                [72 ]First Surgical clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade 8, Belgrade, Serbia
                Article
                1749-7922-7-36
                10.1186/1749-7922-7-36
                3539964
                23190741
                df10628c-203c-44ab-b939-ec2c47c20de4
                Copyright ©2012 Sartelli et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 November 2012
                : 26 November 2012
                Categories
                Research Article

                Surgery
                Surgery

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