Complicated intra-abdominal infections worldwide Sartelli

The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001). * Correspondence: massimosartelli@gmail.com Department of Surgery, Macerata Hospital, Macerata, Italy Full list of author information is available at the end of the article © 2014 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/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Sartelli et al. World Journal of Emergency Surgery 2014, 9:37 Page 2 of 10 http://www.wjes. org/content/9/1/37 Introduction Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to faecal peritonitis [1]. In the event of complicated IAI the infection proceeds beyond a singularly affected organ and causes either localized peritonitis (intra-abdominal abscesses) or diffuse peritonitis. Effectively treating patients with complicated intra-abdominal infections involves both source control and antimicrobial therapy [2,3]. In order to describe the epidemiological, clinical, microbiological, and surgical treatment profiles of complicated intra-abdominal infections (IAIs) in Europe, the World Society of Emergency Surgery (WSES) designed the CIAO Study (Complicated intra-abdominal infections observational study). The CIAO Study was conducted during 2012 across twenty European countries [4]. Given the interesting results of the CIAO Study, WSES designed a prospective observational study investigating the management of complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). In January 2013 the preliminary results (2-month study period) of the CIAOW study were published [5]. WSES presents the definitive data of the CIAOW Study. Methods Aim The purpose of the study was to describe the clinical, microbiological, and treatment profiles of both communityand healthcare-acquired complicated IAIs in a worldwide context. Figure 1 Participating centers for each continent. Patients older than 18 years with both communityacquired and healthcare-associated IAIs were included in the database. Study population The CIAOW study is a multicenter observational study underwent in 68 medical institutions worldwide. The study included patients undergoing surgery or interventional drainage to address complicated IAIs. Medical institutions from each continent participated in the study. The geographical distribution of the participating centers are represented in Figure 1. Study design The study did not attempt to change or modify the laboratory or clinical practices of the participating physicians, and neither informed consent nor formal approval by an Ethics Committee were required. The study met the standards outlined in the Declaration of Helsinki and Good Epidemiological Practices. The study was monitored by the coordination center, which investigated and verified missing or unclear data submitted to the central database. This study was performed under the direct supervision of the board of directors of WSES. Data collection In each centre, the coordinator collected and compiled data in an online case report system. These data included the following: (i) patient and disease characteristics, i.e., demographic data, type of infection (communityor healthcare-acquired), severity criteria, previous curative antibiotic therapy administered in the 7 days preceding surgery; (ii) origin of infection and surgical procedures performed; and (iii) microbiological data, i.e., identification of bacteria and microbial pathogens within the peritoneal Table 1 Clinical findings Clinical findings Patients