Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

World Journal of Emergency Surgery, Jan 2013

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients. The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

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Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

World Journal of Emergency Surgery Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study) Massimo Sartelli 0 Fausto Catena Luca Ansaloni Ernest Moore Mark Malangoni George Velmahos Raul Coimbra Kaoru Koike Ari Leppaniemi Walter Biffl Zsolt Balogh Cino Bendinelli Sanjay Gupta Yoram Kluger Ferdinando Agresta Salomone Di Saverio Gregorio Tugnoli Elio Jovine Carlos Ordonez Carlos Augusto Gomes Gerson Alves Pereira Junior Kuo-Ching Yuan Miklosh Bala Miroslav P Peev Yunfeng Cui Sanjay Marwah Sanoop Zachariah Boris Sakakushev Victor Kong Adamu Ahmed Ashraf Abbas Ricardo Alessandro Teixeira Gonsaga Gianluca Guercioni Nereo Vettoretto Elia Poiasina Offir Ben-Ishay Rafael Díaz-Nieto Damien Massalou Matej Skrovina Ihor Gerych Goran Augustin Jakub Kenig Vladimir Khokha Cristian Tranà Kenneth Yuh Yen Kok Alain Chichom Mefire Jae Gil Lee Suk-Kyung Hong Helmut Alfredo Segovia Lohse Wagih Ghnnam Alfredo Verni Varut Lohsiriwat Boonying Siribumrungwong Alberto Tavares Gianluca Baiocchi Koray Das Julien Jarry Maurice Zida Norio Sato Kiyoshi Murata Tomohisa Shoko Takayuki Irahara Ahmed O Hamedelneel Noel Naidoo Abdul Rashid Kayode Adesunkanmi Yoshiro Kobe AK Attri Rajeev Sharma Federico Coccolini Tamer El Zalabany Khalid Al Khalifa Juan Sanjuan Rita Barnabé Wataru Ishii 0 Department of Surgery, Macerata Hospital , Macerata , Italy Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18-98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients. The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013. - Introduction Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis [1]. From a clinical perspective, IAIs are classified in two major categories: complicated and uncomplicated. In uncomplicated IAIs, the infectious process only involves a single organ and does not spread to the peritoneum. Patients with such infections can be managed with either surgical resection or antibiotics. When the focus of infection is treated effectively by surgical excision, 24-hour perioperative prophylaxis is typically sufficient. Patients with less severe intra-abdominal infections, including acute diverticulitis and certain forms of acute appendicitis, may be treated non-operatively. In complicated IAIs, the infectious process extends beyond a singularly affected organ, and causes either localized peritonitis or diffuse peritonitis. The treatment of patients with complicated intra-abdominal infections involves both source control and antibiotic therapy. Intra-abdominal infections are further classified in two groups: community-acquired intra-abdominal infections (CA-IAIs) and healthcare-associated intra-abdominal infections (HA-IAIs). CA-IAIs are acquired directly in the community while HA-IAIs develop in hospitalized patients or residents of long-term healthcare facilities. HA-IAIs are associated with higher rates of mortality due to the patients’ poorer underlying health and an increased likelihood of infection by multi-drug resistant microorganisms. Source control encompasses all measures undertaken to eliminate the source of infection and to control ongoing contamination. The most common source of infection in communityacquired intra-abdominal infections is the appendix, followed by the colon, and then the stomach. Dehiscence complicates 5-10% of intra-abdominal bowel anastomoses and is associated with high rates of mortality [2]. Ultrasound- and CT-guided percutaneous drainage (...truncated)


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Massimo Sartelli, Fausto Catena, Luca Ansaloni, Ernest Moore, Mark Malangoni, George Velmahos, Raul Coimbra, Kaoru Koike, Ari Leppaniemi, Walter Biffl, Zsolt Balogh, Cino Bendinelli, Sanjay Gupta, Yoram Kluger, Ferdinando Agresta, Salomone Di Saverio, Gregorio Tugnoli, Elio Jovine, Carlos Ordonez, Carlos Augusto Gomes, Gerson Alves Pereira, Kuo-Ching Yuan, Miklosh Bala, Miroslav P Peev, Yunfeng Cui, Sanjay Marwah, Sanoop Zachariah, Boris Sakakushev, Victor Kong, Adamu Ahmed, Ashraf Abbas, Ricardo Alessandro Teixeira Gonsaga, Gianluca Guercioni, Nereo Vettoretto, Elia Poiasina, Offir Ben-Ishay, Rafael Díaz-Nieto, Damien Massalou, Matej Skrovina, Ihor Gerych, Goran Augustin, Jakub Kenig, Vladimir Khokha, Cristian Tranà, Kenneth Yuh Yen Kok, Alain Chichom Mefire, Jae Gil Lee, Suk-Kyung Hong, Helmut Alfredo Segovia Lohse, Wagih Ghnnam, Alfredo Verni, Varut Lohsiriwat, Boonying Siribumrungwong, Alberto Tavares, Gianluca Baiocchi, Koray Das, Julien Jarry, Maurice Zida, Norio Sato, Kiyoshi Murata, Tomohisa Shoko, Takayuki Irahara, Ahmed O Hamedelneel, Noel Naidoo, Abdul Rashid Kayode Adesunkanmi, Yoshiro Kobe, AK Attri, Rajeev Sharma, Federico Coccolini, Tamer El Zalabany, Khalid Al Khalifa, Juan Sanjuan, Rita Barnabé, Wataru Ishii. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study), World Journal of Emergency Surgery, 2013, pp. 1, 8, DOI: 10.1186/1749-7922-8-1