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Background <p>Intra-abdominal infections are complex and potentially life-threatening conditions frequently requiring intensive care admission and are associated with highly variable mortality driven by disease severity, host response, comorbidities, and antimicrobial resistance.</p> <p>Outcomes depend on timely diagnosis, effective surgical source control, appropriate antimicrobial therapy, and a coordinated multidisciplinary approach addressing both the infectious and systemic inflammatory components of the disease.</p> Material and method <p>This was a prospective, observational nationwide study. We included all adult patients admitted to the hospital with complicated abdominal infections requiring ICU admission. The aim of this study was to describe the epidemiology and outcomes of patients admitted to the hospital with intra-abdominal infections (IAIs) requiring an intensive care unit (ICU) admission in 23 Italian hospitals.</p> Results <p>A total of 784 patients admitted to the hospital with complicated <i>IAIs</i> requiring <i>ICU</i> admission were enrolled. Overall, in-hospital mortality among ICU patients was 23.9%. Septic shock (36.2%) and sepsis (35.9%) were the main reasons for ICU admission. Community-acquired infections accounted for 64.8% of cases, and adequate source control was achieved in 61.5% of patients. Re-operation was required in 21%.</p> <p>The most frequently isolated pathogens were&#xa0;<i>Escherichia coli</i> (23.1%), followed by&#xa0;<i>Enterococcus</i>&#xa0;spp. (15.4%). Empiric antibiotic therapy was prescribed in more than 80% of patients (median duration ranging from 8.1 to 19.3&#xa0;days). Piperacillin–tazobactam was the most commonly used antibiotic. In multivariable logistic regression analysis, increasing age (OR 1.04 per year, 95% CI 1.03–1.06), immunosuppression (OR 1.99, 95% CI 1.09–3.66), serious cardiovascular disease (OR 1.91, 95% CI 1.20–3.05), re-operation (OR 2.30, 95% CI 1.34–3.96), inadequate source control (OR 0.39, 95% CI 0.22–0.71), peritonitis (OR 0.39, 95% CI 0.23–0.66), and healthcare-associated infections (OR 1.83, 95% CI 1.10–3.04) were independently associated with in-hospital mortality. Duration of antibiotic therapy, malignancy, and delay in initial intervention were not significantly associated with mortality.</p> Conclusion <p>Septic shock remains the leading cause of <i>ICU</i> admission in patients with <i>IAIs</i>. Patients with&#xa0;immunosuppression, serious cardiovascular comorbidities, requirement for re-operation, inadequate source control, peritonitis, and healthcare-associated infections were at significantly higher risk of in-hospital mortality. Overall, our study reinforces the multifactorial nature of mortality in critically ill patients with intra-abdominal infections, highlighting modifiable factors (source control, timely intervention) that can be targeted to improve outcomes.</p>

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Epidemiology and outcome of intra-abdominal infections in intensive care unit in Italy from the Italian Register of complicated Intra-abdominal InfectionS—the IRIS study: a prospective observational nationwide study

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  • 发表日期：

    2026年1月20日

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  • Etrusca Brogi,
  • Camilla Cremonini,
  • Marco Ceresoli,
  • Fausto Catena,
  • Angela Gurrado,
  • Francesco Forfori,
  • Lorenzo Ghiadoni,
  • Ettore Melai,
  • Serena Musetti,
  • Luigi Cobuccio,
  • Ismail Cengeli,
  • Dario Tartaglia,
  • Filippo Vagelli,
  • Giuseppe Zocco,
  • Silvia Strambi,
  • Francesco Arces,
  • Alice Salamone,
  • Rossella Facchin,
  • Riccardo Guelfi,
  • Jacopo Giuliani,
  • Rachele Monetti,
  • Massimo Chiarugi,
  • Alessandro Cipriano,
  • Francesco Corradi,
  • Angelo Baggiani,
  • Caterina Rizzo,
  • Carmelo Mazzeo,
  • Eugenio Cucinotta,
  • Mario Testini,
  • Vittoria Giovane,
  • Francesco Prete,
  • Alessandro Pasculli,
  • Gianluca Costa,
  • Alessio Mazzoni,
  • Davina Perini,
  • Alessandra Risso,
  • Andrea Spota,
  • Alan Biloslavo,
  • Alessandra Sguera,
  • Marco Anania,
  • Risso Alessandra,
  • Carlo Vallicelli,
  • Carlo Mazzucchelli,
  • Giulia Ciabatti,
  • Claudia Zaghi,
  • Daniele Delogu,
  • Dario Iadicola,
  • Dario Parini,
  • Daunia Verdi,
  • Diego Visconti,
  • Davide Luppi,
  • Fabio Cavallo,
  • Edoardo Ballauri,
  • Elia Giuseppe Lunghi,
  • Emanuele Doria,
  • Fausto Rosa,
  • Federica Chimenti,
  • Fioralba Pindozzi,
  • Francesca Sbuelz,
  • Francesca Cammelli,
  • Mario Herda,
  • Francesca D’Agostino,
  • Giacomo Carganico,
  • Franco Badile,
  • Giovanni Gambino,
  • Giovanni Pirozzolo,
  • Giuseppe Brisinda,
  • Alberto Vannelli,
  • Leonardo Andrea Delogu,
  • Lorenzo Gamberini,
  • Maria Grazia Sibilla,
  • Matteo Nardi,
  • Mauro Podda,
  • Maximilian Scheiterle,
  • Michela Giulii Capponi,
  • Michele Malerba,
  • Marco Milone,
  • Luisa Moretti,
  • Nicola Cillara,
  • Noemi Di Fuccia,
  • Pierpaolo Di Lascio,
  • Pietro Fransvea,
  • Sonia Agrusti,
  • Mauro Santarelli,
  • Stefano Piero Bernardo Cioffi,
  • Stefania Cimbanassi,
  • Michele Altomare,
  • Francesco Virdis,
  • Stefano Scabini,
  • Beatrice Torre,
  • Valentina Murzi,
  • Francesco Salvetti,
  • Paola Fugazzola,
  • Nita Gabriela Elisa,
  • Giovanni Bellanova,
  • Monica Zese,
  • Davide Luppi,
  • Luigi Romeo,
  • Andrea Muratore,
  • Elia Giuseppe Lunghi,
  • Rocco Scalzone,
  • Stefano Perrone,
  • Savino Occhionorelli,
  • Francesca Gubbiotti,
  • Rosa Scaramuzzo,
  • Roberta Gelmini,
  • Vincenzo Pappalardo,
  • Filippo Paratore,
  • Elena Adelina Toma,
  • Fabio Benedetti,
  • Massimo Sartelli,
  • Federico Coccolini

摘要

Background

Intra-abdominal infections are complex and potentially life-threatening conditions frequently requiring intensive care admission and are associated with highly variable mortality driven by disease severity, host response, comorbidities, and antimicrobial resistance.

Outcomes depend on timely diagnosis, effective surgical source control, appropriate antimicrobial therapy, and a coordinated multidisciplinary approach addressing both the infectious and systemic inflammatory components of the disease.

Material and method

This was a prospective, observational nationwide study. We included all adult patients admitted to the hospital with complicated abdominal infections requiring ICU admission. The aim of this study was to describe the epidemiology and outcomes of patients admitted to the hospital with intra-abdominal infections (IAIs) requiring an intensive care unit (ICU) admission in 23 Italian hospitals.

Results

A total of 784 patients admitted to the hospital with complicated IAIs requiring ICU admission were enrolled. Overall, in-hospital mortality among ICU patients was 23.9%. Septic shock (36.2%) and sepsis (35.9%) were the main reasons for ICU admission. Community-acquired infections accounted for 64.8% of cases, and adequate source control was achieved in 61.5% of patients. Re-operation was required in 21%.

The most frequently isolated pathogens were Escherichia coli (23.1%), followed by Enterococcus spp. (15.4%). Empiric antibiotic therapy was prescribed in more than 80% of patients (median duration ranging from 8.1 to 19.3 days). Piperacillin–tazobactam was the most commonly used antibiotic. In multivariable logistic regression analysis, increasing age (OR 1.04 per year, 95% CI 1.03–1.06), immunosuppression (OR 1.99, 95% CI 1.09–3.66), serious cardiovascular disease (OR 1.91, 95% CI 1.20–3.05), re-operation (OR 2.30, 95% CI 1.34–3.96), inadequate source control (OR 0.39, 95% CI 0.22–0.71), peritonitis (OR 0.39, 95% CI 0.23–0.66), and healthcare-associated infections (OR 1.83, 95% CI 1.10–3.04) were independently associated with in-hospital mortality. Duration of antibiotic therapy, malignancy, and delay in initial intervention were not significantly associated with mortality.

Conclusion

Septic shock remains the leading cause of ICU admission in patients with IAIs. Patients with immunosuppression, serious cardiovascular comorbidities, requirement for re-operation, inadequate source control, peritonitis, and healthcare-associated infections were at significantly higher risk of in-hospital mortality. Overall, our study reinforces the multifactorial nature of mortality in critically ill patients with intra-abdominal infections, highlighting modifiable factors (source control, timely intervention) that can be targeted to improve outcomes.