title: Enterococci increase the morbidity and mortality associated with severe intra-abdominal infections in elderly patients hospitalized in the intensive care unit.
abstract: OBJECTIVE
  Enterococci may increase morbidity and mortality in elderly patients with intra-abdominal infections (IAIs) hospitalized in the intensive care unit (ICU).
  
  
  METHODS
  A single-centre, retrospective evaluation of an ICU database (1997-2007) of elderly ICU patients (≥75 years) with a severe IAI was performed. Demographics, severity scores, underlying diseases, microbiology and outcomes were recorded. Patients with enterococci isolated in peritoneal fluid (E+ group) were compared with those lacking enterococci in peritoneal fluid (E- group). Stepwise multivariate logistic regression was used to identify independent factors associated with mortality.
  
  
  RESULTS
  One hundred and sixty patients were included (mean ± SD age 82 ± 5 years; n = 72 in the E+ group). The E+ group was more severely ill than the E- group, with higher Simplified Acute Physiologic Score 2 (61 ± 20 versus 48 ± 16, P = 0.0001) and Sequential Organ Failure Assessment scores (8 ± 3 versus 5 ± 3, P = 0.0001), a greater postoperative infection rate (58.3% versus 34.1%, P = 0.01), a higher incidence of inappropriate empirical antimicrobial therapies (33.3% versus 19.3%, P = 0.04), a longer duration of mechanical ventilation (11.8 ± 10.9 versus 7.8 ± 10.2 days, P = 0.02) and greater vasopressor use (7.2 ± 7.1 versus 3.3 ± 4.1 days, P = 0.001). ICU mortality was higher in the E+ group than in the E- group (54.2% versus 38.6%, P = 0.05). In the multivariate analysis, E+ status was independently associated with mortality (odds ratio 2.24; 95% confidence interval 1.06-4.75; P = 0.03).
  
  
  CONCLUSIONS
  In severely ill, elderly patients in the ICU for an IAI, the isolation of enterococci was associated with increased disease severity and morbidity and was an independent risk factor for mortality.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire d'Amiens, Place Victor Pauchet, 80054 Amiens cedex, France. dupont.herve@chu-amiens.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.forename: Arnaud
authors.initials: A
authors.lastname: Friggeri
authors.forename: Jérémy
authors.initials: J
authors.lastname: Touzeau
authors.forename: Norair
authors.initials: N
authors.lastname: Airapetian
authors.forename: François
authors.initials: F
authors.lastname: Tinturier
authors.forename: Eric
authors.initials: E
authors.lastname: Lobjoie
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
authors.forename: Moustafa
authors.initials: M
authors.lastname: Hijazi
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Régimbeau
authors.forename: Yazine
authors.initials: Y
authors.lastname: Mahjoub
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D056569:Enterococcaceae / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D059413:Intraabdominal Infections / Q000382:microbiology* / Q000401:mortality*; D008297:Male; D009102:Multiple Organ Failure / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome