Memoria de Trabajo y Envejecimiento: Rendimiento en el Test de Memoria de Trabajo Visoespacial Computarizado (TMTV-C)

Màster Oficial de Psicogerontologia, Facultat de Psicologia, Universitat de Barcelona, curs: 2015-2016, Tutors: Josep Lluís Conde-Sala i Lorena Rami GonzálezIntroducción: El envejecimiento es un proceso en el cual se evidencian cambios cognitivos de algunas funciones superiores. En este contexto, la memoria es uno de los dominios cognitivos más afectados, especialmente la memoria de trabajo (MT), la cual se entiende como aquel almacenamiento temporal y a corto plazo, que permite mantener los elementos que son relevantes para la tarea que se debe ejecutar. Algunos estudios señalan que el rendimiento en la MT se deteriora durante la edad adulta, sobretodo en la aquellas personas mayores de 60 años, donde el componente visoespacial se encuentra especialmente afectado. Este fenómeno sucede tanto en personas sanas como aquellas que poseen alguna enfermedad neurodegenerativa. Objetivo: Desarollar y aplicar el Test de Memoria de Trabajo Visoespacial Computarizado (TMTV-C) para observar el rendimiento en MT visoespacial en tres grupos de diferentes edades, con el fin de identificar si existe una disminución de este componente a medida que se envejece. Por otra parte, era objetivo específico observar si el grupo de adultos de edad avanzada presentaba un rendimiento significativamente más alterado en comparación con los otros grupos evaluados. Se utilizó un Eye Tracker para monitorear los movimientos oculares y así medir la precisión de la respuesta de cada sujeto. Metodología: Estudio no experimental, descriptivo, observacional, y transversal, en el cual se comparó la precisión de respuesta en la prueba TMTV-C, en 3 grupos: 5 adultos jóvenes (25-40 años) 5 adultos de mediana edad (40-55 años) y 5 sujetos de edad avanzada (55 y más años). Los errores examinados fueron los de ángulo y de módulo, además de medir la probabilidad de respuestas en objetivo, probabilidad de respuestas no objetivo y probabilidad de respuestas al azar. Se aplicó el Test de Alteración de Memoria (T@M) como test de cribado cognitivo, el Test de Acentuación de Palabras (TAP) para medir inteligencia premórbida, una prueba agudeza visual, el Test de daltonismo de Ishibara y la TMTV-C. Resultados: Se observa un rendimiento deficitario en todas las dimensiones analizadas, en la comparación entre el grupo de adultos de mediana edad y el grupo de edad avanzada. Existe una mayor presencia de errores de ángulo y errores de módulo, menor probabilidad de respuestas objetivo, y mayor probabilidad de respuestas no objetivo y probabilidad de respuestas al azar. A medida que se aumentaba la carga de estímulos (1, 3 o 5) y se incrementaba el tiempo de presentación estímulo-respuesta (0 seg., 3 seg. o 6 seg.), el rendimiento empeoraba. Discusión: Con los resultados obtenidos cabe señalar que el grupo de personas de edad avanzada obtiene una menor precisión en sus respuestas en TMTV-C, por lo cual podría concluirse que presentan un deterioro en MT visoespacial, en comparación con los otros grupos analizados. Para explicar las disminuciones observadas, se han barajado diversas teorías como disminución en la velocidad de procesamiento, falta de control inhibitorio, menor cantidad de recursos atencionales y alteración en el mantenimiento de los bindings

Cognitive impairment with Type 2 Diabetes Mellitus among community-dwelling older adults in Chile:Prevalence, risk factors and cognitive characteristics

INTRODUCTION: The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group. METHODOLOGY: A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student’s t-tests and MANOVA. RESULTS: Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, p < 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between “cognition” and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group. CONCLUSION: The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile

Numero de años con diabetes mellitus tipo 2 y su asociación con la sospecha de deterioro cognitivo en personas mayores chilenas: Un estudio transversal

Introduction: The average life expectancy, as well as the prevalence of Type 2 diabetes (T2D), is increasing worldwide. Population-based studies have demonstrated that the duration of T2D has been associated with cognitive impairment. However, despite the high prevalence of T2D and cognitive impairment in Chile, the association between years with T2D and suspicion of cognitive impairment has not yet been investigated. The objective of this study was to investigate the association between duration of T2D and suspicion of cognitive impairment in Chilean older adults. Material and Methods: 1,040 older adults aged ≥60 years from the Chilean National Health Survey (2009–2010) were included. Suspicion of cognitive impairment was assessed by the abbreviated Mini-Mental State Examination (MMSE). The number of years with T2D was self-reported and categorised into four groups.  Poisson Regression analysis was used to assess the association between altered MMSE and the number of years with DM2, adjusted by potential confounders including socio-demographic, lifestyle, adiposity and health-related factors. Results: When the analyses were adjusted for socio-demographic factors, people who had T2D for 15 to 24 and ≥25 years had 2.2-times (95% CI: 1.07; 3.33) and 5.8-times (95% CI: 3.81; 11.0) higher relative risk (RR) of cognitive impairment, compared to those without T2D. When the analyses were additionally adjusted for lifestyle and health-related covariates, the RR for cognitive impairment was 1.76-times (95% CI: 1.02; 2.50) and 4.54-times (95% CI: 2.70; 6.38) higher for those who had T2D for 14-24 years and ≥25 years, respectively. Conclusions: Number of years with T2D was associated with suspicion of cognitive impairment. A longer duration of T2D was associated with a higher likelihood of cognitive impairment in the Chilean older population, independently of confounder factors included in the study.Introduction: La esperanza de vida está aumentando en todo el mundo, así como la diabetes tipo 2 (DM2). Estudios poblacionales han demostrado que la duración de la DM2 se ha asociado con el deterioro cognitivo. Sin embargo, a pesar de la alta prevalencia de DM2 y deterioro cognitivo en Chile, aún no se ha investigado la asociación entre años con DM2 y la sospecha de deterioro cognitivo. El objetivo del estudio fue investigar la asociación entre la duración de la diabetes mellitus 2 (DM2) y la sospecha de deterioro cognitivo en personas mayores chilenas. Métodos: Participaron 1.040 personas ≥60 años de la Encuesta Nacional de Salud de Chile (2009-2010). El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental abreviado (MMSE). El número de años con DM2 fue categorizado en cuatro grupos. Para valorar la asociación entre MMSE alterado y el número de años con DM2, se utilizó una regresión de  Poisson, ajustados a posibles factores de confusión sociodemograficos, de estilos de vida, adiposidad y salud. Resultados: Cuando se ajustaron los análisis por factores sociodemográficos, las personas con 15 a 24 y ≥25 años con DM2 presentaron 2,2 veces (IC 95%: 1,07; 3,33) y 5,8 veces (IC 95%: 3,81; 11,0) riesgo relativo (RR) de deterioro cognitivo, en comparación con aquellas sin DM2. Luego de ajustar adicionalmente los análisis para las covariables relacionadas con el estilo de vida y la salud, el RR para deterioro cognitivo fue 1,76 veces (IC 95%: 1,02; 2,50) y 4,54 veces (IC 95%: 2,70; 6,38) más alto para aquellas personas con 14-24 y ≥25 años de DM2. Conclusiones: Se asoció el número de años con DM2 con la sospecha de deterioro cognitivo. Una mayor duración de la DM2 se asoció con una mayor probabilidad de deterioro cognitivo en la población mayor chilena

Diabetes Mellitus tipo 2 y síndromes geriátricos: Prevalencias y factores de riesgo en personas mayores chilenas

[spa] INTRODUCCIÓN: La diabetes mellitus tipo 2 (DM2) es una enfermedad crónica de alta prevalencia en todo el mundo. Chile tiene el segundo lugar de Sudamérica y 5° de los países OCDE con tasas más elevadas de esta patología. La población de 65 o más años posee una prevalencia de 30,6%, con presencia de frecuencias más altas en mujeres (12%), además de reportarse un riesgo 6,8 veces más alto de tener DM2 en comparación con otros grupos etarios. Por todo lo anterior, el abordaje integral de la DM2 en la persona mayor representa un importante y prioritario desafío de sanidad pública. Tanto las medidas preventivas, como el diagnóstico, complicaciones asociadas y tratamiento de esta enfermedad presentan características diferenciales que la hacen merecedora de consideraciones específicas. La gran variabilidad de la DM2 demanda objetivos individualizados, los cuales deben estar al servicio de aumentar la calidad de vida de la persona mayor con DM2 y su entorno. En este contexto, la amplia evidencia sobre el rol crucial que tiene la DM2 en el desarrollo de diversos Síndromes Geriátricos (SGs), hace urgente identificar las prevalencias y factores de riesgo de estas condiciones de salud de etiología multifactorial, los cuales se asocian a una mala calidad de vida y resultados negativos para la salud, entre otras consecuencias. OBJETIVOS: La presente tesis está compuesta de cuatro estudios, cada uno con su objetivo general propio. El primer estudio tiene fin es determinar las diferencias en la frecuencia de SGs entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 de aquellas que no presentan este diagnóstico. El segundo estudio tiene por fin determinar las diferencias en las características cognitivas entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 de aquellas que no presentan este diagnóstico. A su vez, determinar el perfil neuropsicológico entre las personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2. El tercer estudio tiene por fin determinar los factores de riesgo sociodemográficos, clínicos y de estilos de vida entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 y SGs. El cuarto estudio tiene por fin determinar si la Diabetes Mellitus 2 es un factor de riesgo para SGs entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2.[eng] INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. Chile has second place in South America and 5th of the OECD countries with the highest rates of this pathology. The population aged 65 or over has a prevalence of 30.6%, with higher frequencies in women (12%), in addition to reporting a 6.8 times higher risk of having T2DM compared to other age groups. Due to the above, the comprehensive approach to T2DM in older adults represents a significant and priority public health challenge. The preventive measures, as well as the diagnosis, associated complications and treatment of this disease, present differential characteristics that make it worthy of specific considerations. The significant variability of T2DM demands individualized objectives, which must be at the service of increasing the quality of life of the older adult with T2DM and their environment. In this context, the extensive evidence on the crucial role that T2DM plays in the development of various Geriatric Syndromes (GS) makes it urgent to identify the prevalence and risk factors of these health conditions of multifactorial etiology, which are associated with a poor quality of life and adverse health outcomes, among other consequences. OBJECTIVES: This thesis comprises four studies, each with its own general objective. The first study aims to determine the differences in the frequency of geriatric syndromes among Chilean people aged 65 or over diagnosed with T2DM and those who do not have this diagnosis. The purpose of the second study is to determine the differences in cognitive characteristics between Chilean people aged 65 or over with a diagnosis of T2DM from those who do not have this diagnosis. In turn, to determine the neuropsychological profile among Chilean people aged 65 or over diagnosed with T2DM. The third study aims to determine the sociodemographic, clinical and lifestyle risk factors among Chilean people aged 65 or over diagnosed with T2DM and GS. The fourth study aims to determine if T2DM is a risk factor for GS among Chilean people aged 65 or over diagnosed with T2DM

Diabetes Mellitus tipo 2 y síndromes geriátricos: Prevalencias y factores de riesgo en personas mayores chilenas

Programa de Doctorat en Medicina i Recerca Translacional[spa] INTRODUCCIÓN: La diabetes mellitus tipo 2 (DM2) es una enfermedad crónica de alta prevalencia en todo el mundo. Chile tiene el segundo lugar de Sudamérica y 5° de los países OCDE con tasas más elevadas de esta patología. La población de 65 o más años posee una prevalencia de 30,6%, con presencia de frecuencias más altas en mujeres (12%), además de reportarse un riesgo 6,8 veces más alto de tener DM2 en comparación con otros grupos etarios. Por todo lo anterior, el abordaje integral de la DM2 en la persona mayor representa un importante y prioritario desafío de sanidad pública. Tanto las medidas preventivas, como el diagnóstico, complicaciones asociadas y tratamiento de esta enfermedad presentan características diferenciales que la hacen merecedora de consideraciones específicas. La gran variabilidad de la DM2 demanda objetivos individualizados, los cuales deben estar al servicio de aumentar la calidad de vida de la persona mayor con DM2 y su entorno. En este contexto, la amplia evidencia sobre el rol crucial que tiene la DM2 en el desarrollo de diversos Síndromes Geriátricos (SGs), hace urgente identificar las prevalencias y factores de riesgo de estas condiciones de salud de etiología multifactorial, los cuales se asocian a una mala calidad de vida y resultados negativos para la salud, entre otras consecuencias. OBJETIVOS: La presente tesis está compuesta de cuatro estudios, cada uno con su objetivo general propio. El primer estudio tiene fin es determinar las diferencias en la frecuencia de SGs entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 de aquellas que no presentan este diagnóstico. El segundo estudio tiene por fin determinar las diferencias en las características cognitivas entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 de aquellas que no presentan este diagnóstico. A su vez, determinar el perfil neuropsicológico entre las personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2. El tercer estudio tiene por fin determinar los factores de riesgo sociodemográficos, clínicos y de estilos de vida entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2 y SGs. El cuarto estudio tiene por fin determinar si la Diabetes Mellitus 2 es un factor de riesgo para SGs entre personas chilenas de 65 años o más con diagnóstico de Diabetes Mellitus 2.[eng] INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. Chile has second place in South America and 5th of the OECD countries with the highest rates of this pathology. The population aged 65 or over has a prevalence of 30.6%, with higher frequencies in women (12%), in addition to reporting a 6.8 times higher risk of having T2DM compared to other age groups. Due to the above, the comprehensive approach to T2DM in older adults represents a significant and priority public health challenge. The preventive measures, as well as the diagnosis, associated complications and treatment of this disease, present differential characteristics that make it worthy of specific considerations. The significant variability of T2DM demands individualized objectives, which must be at the service of increasing the quality of life of the older adult with T2DM and their environment. In this context, the extensive evidence on the crucial role that T2DM plays in the development of various Geriatric Syndromes (GS) makes it urgent to identify the prevalence and risk factors of these health conditions of multifactorial etiology, which are associated with a poor quality of life and adverse health outcomes, among other consequences. OBJECTIVES: This thesis comprises four studies, each with its own general objective. The first study aims to determine the differences in the frequency of geriatric syndromes among Chilean people aged 65 or over diagnosed with T2DM and those who do not have this diagnosis. The purpose of the second study is to determine the differences in cognitive characteristics between Chilean people aged 65 or over with a diagnosis of T2DM from those who do not have this diagnosis. In turn, to determine the neuropsychological profile among Chilean people aged 65 or over diagnosed with T2DM. The third study aims to determine the sociodemographic, clinical and lifestyle risk factors among Chilean people aged 65 or over diagnosed with T2DM and GS. The fourth study aims to determine if T2DM is a risk factor for GS among Chilean people aged 65 or over diagnosed with T2DM

Numero de años con diabetes mellitus tipo 2 y su asociación con la sospecha de deterioro cognitivo en personas mayores chilenas: Un estudio transversal

Introduction: The average life expectancy, as well as the prevalence of Type 2 diabetes (T2D), is increasing worldwide. Population-based studies have demonstrated that the duration of T2D has been associated with cognitive impairment. However, despite the high prevalence of T2D and cognitive impairment in Chile, the association between years with T2D and suspicion of cognitive impairment has not yet been investigated. The objective of this study was to investigate the association between duration of T2D and suspicion of cognitive impairment in Chilean older adults. Material and Methods: 1,040 older adults aged ≥60 years from the Chilean National Health Survey (2009-2010) were included. Suspicion of cognitive impairment was assessed by the abbreviated Mini-Mental State Examination (MMSE). The number of years with T2D was self-reported and categorised into four groups. Poisson Regression analysis was used to assess the association between altered MMSE and the number of years with DM2, adjusted by potential confounders including socio-demographic, lifestyle, adiposity and health-related factors. Results: When the analyses were adjusted for socio-demographic factors, people who had T2D for 15 to 24 and ≥25 years had 2.2-times (95%CI: 1.07; 3.33) and 5.8-times (95%CI: 3.81; 11.0) higher relative risk (RR) of cognitive impairment, compared to those without T2D. When the analyses were additionally adjusted for lifestyle and health-related covariates, the RR for cognitive impairment was 1.76-times (95%CI: 1.02; 2.50) and 4.54-times (95%CI: 2.70; 6.38) higher for those who had T2D for 14-24 years and ≥25 years, respectively. Conclusions: Number of years with T2D was associated with suspicion of cognitive impairment. A longer duration of T2D was associated with a higher likelihood of cognitive impairment in the Chilean older population, independently of confounder factors included in the study.Introduction: La esperanza de vida está aumentando en todo el mundo, así como la diabetes tipo 2 (DM2). Estudios poblacionales han demostrado que la duración de la DM2 se ha asociado con el deterioro cognitivo. Sin embargo, a pesar de la alta prevalencia de DM2 y deterioro cognitivo en Chile, aún no se ha investigado la asociación entre años con DM2 y la sospecha de deterioro cognitivo. El objetivo del estudio fue investigar la asociación entre la duración de la diabetes mellitus 2 (DM2) y la sospecha de deterioro cognitivo en personas mayores chilenas. Métodos: Participaron 1.040 personas ≥60 años de la Encuesta Nacional de Salud de Chile (2009-2010). El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental abreviado (MMSE). El número de años con DM2 fue categorizado en cuatro grupos. Para valorar la asociación entre MMSE alterado y el número de años con DM2, se utilizó una regresión de Poisson, ajustados a posibles factores de confusión sociodemograficos, de estilos de vida, adiposidad y salud. Resultados: Cuando se ajustaron los análisis por factores sociodemográficos, las personas con 15 a 24 y ≥25 años con DM2 presentaron 2,2 veces (IC 95%: 1,07; 3,33) y 5,8 veces (IC 95%: 3,81; 11,0) riesgo relativo (RR) de deterioro cognitivo, en comparación con aquellas sin DM2. Luego de ajustar adicionalmente los análisis para las covariables relacionadas con el estilo de vida y la salud, el RR para deterioro cognitivo fue 1,76 veces (IC 95%: 1,02; 2,50) y 4,54 veces (IC 95%: 2,70; 6,38) más alto para aquellas personas con 14-24 y ≥25 años de DM2. Conclusiones: Se asoció el número de años con DM2 con la sospecha de deterioro cognitivo. Una mayor duración de la DM2 se asoció con una mayor probabilidad de deterioro cognitivo en la población mayor chilena

Number of years with type 2 diabetes is associated with cognitive impairment in Chilean older adults: A cross-sectional study

Introduction: The average life expectancy, as well as the prevalence of Type 2 diabetes (T2D), is increasing worldwide. Population-based studies have demonstrated that the duration of T2D has been associated with cognitive impairment. However, despite the high prevalence of T2D and cognitive impairment in Chile, the association between years with T2D and suspicion of cognitive impairment has not yet been investigated. The objective of this study was to investigate the association between duration of T2D and suspicion of cognitive impairment in Chilean older adults. Material and Methods: 1,040 older adults aged ≥60 years from the Chilean National Health Survey (2009-2010) were included. Suspicion of cognitive impairment was assessed by the abbreviated Mini-Mental State Examination (MMSE). The number of years with T2D was self-reported and categorised into four groups. Poisson Regression analysis was used to assess the association between altered MMSE and the number of years with DM2, adjusted by potential confounders including socio-demographic, lifestyle, adiposity and health-related factors. Results: When the analyses were adjusted for socio-demographic factors, people who had T2D for 15 to 24 and ≥25 years had 2.2-times (95%CI: 1.07; 3.33) and 5.8-times (95%CI: 3.81; 11.0) higher relative risk (RR) of cognitive impairment, compared to those without T2D. When the analyses were additionally adjusted for lifestyle and health-related covariates, the RR for cognitive impairment was 1.76-times (95%CI: 1.02; 2.50) and 4.54-times (95%CI: 2.70; 6.38) higher for those who had T2D for 14-24 years and ≥25 years, respectively. Conclusions: Number of years with T2D was associated with suspicion of cognitive impairment. A longer duration of T2D was associated with a higher likelihood of cognitive impairment in the Chilean older population, independently of confounder factors included in the study

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (&lt; 2 h), 'urgent' (2-6 h), and 'delayed' (&gt; 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value &gt; 12, p &lt; 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (&lt; 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome

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.status: publishe

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

evere 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.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific 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