Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Cheap multichip modules

The opportunity for mutual benefit across Europe to develop low-cost MCM technologies arose from recognition of the scientific skills and design and prototyping capabilities in organic and inorganic circuits in countries of Central Europe. As a results, the leading research institutions and small/medium-size enterprises of Hungary, Romania and Slovenia together with relevant institutions of the United Kingdom and Belgium proposed and received approval for an European Union INCO-COPERNICUS project (IC15-CT96-0743) "Establishment of Fast Prototyping Low Cost Multichip Module Technology Facilities in Eastern Europe for the Benefit of European Industry" (Cheap MultiChip Modules) to establish fast prototyping low cost multichip module (MCM) technology facilities. The project commenced in May 1997. MCM Technologies include the design, manufacturing, assembling and testing phases. The tasks of the Project are divided among the participants in accordance with these technological phases and conforming to their interest and capability in the field. Design is the task of the Rumanian Partners. They have installed CAD systems and developed circuit designs and simulations to determine the design rules and preferences for MCMs. Manufacturing is the task of the Hungarian and Slovenian Partners. They are focusing their laminate and ceramics capabilities towards MCM-L and MCM-C manufacturing and upgrading test technologies up to a level to fulfill the low cost, fast prototyping requirements of the participating Central European Countries (and later Europe-wide). The Hungarian Partner is also establishing mounting and bonding facilities for assembling MCMs in collaboration with the UK and Belgian Partners, exploiting their high level experience in the fields of microjoining and test technologies. The final test of demonstration modules is also the task of the Belgian Partner. The evaluation of the results in accordance with the manufacturing, application and economic aspects will be the task of all Partners with the leadership of the Hungarian Partner. The Project is carried out in close cc-operation of all Partners. In order to disseminate information for and about the Project, the Partnership participates in conferences, organizes seminars and training courses for themselves and for small and medium size enterprises who show interest in the prototyping technology of MCMs. Considerable progress has been made in the design facilities by the Rumanian Partner, and in the refinement of the printed circuit board (PCB) technology at Budapest, including laser patterning of MCM-Ls. Diffusion patterning and ceramics technology skills in Slovenia are enabling MCM-C prototyping to be demonstrated and further developed

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed