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Multidrug resistance in community acquired intra-abdominal infections
Pritish John Korula1, Rajasekar Arumugam1, Visali Jeyaseelan2, Rajat Ragunath3, Kandasamy Subramani1, Priscilla Rupali4
1Department of Surgical Intensive Care, 2Department of Biostatistics, 3Department of Colorectal Surgery, 4Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, India.

Corresponding Author
Dr Pritish John Korula


Background: Community Acquired Intra-Abdominal Infections (IAI’s) secondary to hollow viscous perforations are not uncommon reasons for ICU admission in our country. It is unclear if high rates of Multidrug Resistant Organisms (MRO) are associated with adverse ICU outcomes in these infections. 
Aim: To verify the impact of MRO in peritoneal isolates of patients with hollow viscous perforation on ICU outcomes 
Methods: Retrospective cohort study of patients admitted to the SICU during a two-year period (Jan 2014 to Dec 2015) with community acquired IAI. Primary outcomes were ICU free stay differences between MRO positive and negative patients. Secondary outcomes were adverse outcomes (death or terminal discharge), hospital-free stay and complications. 
Results: Among 2,581 patients admitted to the ICU over the study period (January 2014 to December 2015), 117 patients were admitted with community acquired hollow viscus perforation peritonitis. The most common cause was gastro-duodenal perforation (43.5%). The most common empirical antibiotics were ß-Lactam/ß- Lactam inhibitor (BLBLIs) in 64.1% of the patients,  while carbapenems were the most common post-op antibiotics (55.6%). Sixty-five percent of patients had source control performed with 24 hours of admission. Patients with MRO positive isolates as the causative pathogens presented relatively later (median of 3 days since symptom onset); MRO positivity did not impact on ICU length of stay. A univariate analysis revealed APACHE score and prolonged ICU and hospital stay were associated with adverse outcomes (death or terminal discharge). A multivariate analysis failed to show MRO as a risk factor for adverse ICU outcomes.
Conclusion: In a population with moderately high ESBL prevalence, community acquired perforation peritonitis with multidrug resistance pattern of organisms in isolates does not lead to adverse ICU outcomes, when the predominant empirical antibiotics were BLBLIs. Larger prospective and perhaps controlled studies may be needed to substantiate our findings.