Open Access Highly Accessed Research article

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Massimo Sartelli1*, Fausto Catena2, Luca Ansaloni3, Ari Leppaniemi4, Korhan Taviloglu5, Harry van Goor6, Pierluigi Viale7, Daniel Vasco Lazzareschi8, Carlo de Werra9, Daniele Marrelli10, Sergio Colizza11, Rodolfo Scibé1, Halil Alis12, Nurkan Torer13, Salvador Navarro14, Marco Catani15, Saila Kauhanen16, Goran Augustin17, Boris Sakakushev18, Damien Massalou19, Pieter Pletinckx20, Jakub Kenig21, Salomone Di Saverio22, Gianluca Guercioni23, Stefano Rausei24, Samipetteri Laine25, Piotr Major26, Matej Skrovina27, Eliane Angst28, Olivier Pittet29, Ihor Gerych30, Jaan Tepp31, Guenter Weiss32, Giorgio Vasquez33, Nikola Vladov34, Cristian Tranà35, Nereo Vettoretto36, Samir Delibegovic37, Adam Dziki38, Giorgio Giraudo39, Jorge Pereira40, Elia Poiasina3, Helen Tzerbinis41, Martin Hutan42, Andras Vereczkei43, Avdyl Krasniqi44, Charalampos Seretis45, Rafael Diaz-Nieto46, Cristian Mesina47, Miran Rems48, Fabio Cesare Campanile49, Ferdinando Agresta50, Pietro Coletta51, Mirjami Uotila-Nieminen52, Mario Dente53, Konstantinos Bouliaris54, Konstantinos Lasithiotakis55, Vladimir Khokha56, Dragoljub Zivanović57, Dmitry Smirnov58, Athanasios Marinis59, Ionut Negoi60, Ludwig Ney61, Roberto Bini62, Miguel Leon63, Sergio Aloia9, Cyrille Huchon64, Radu Moldovanu65, Renato Bessa de Melo66, Dimitrios Giakoustidis67, Orestis Ioannidis68, Michele Cucchi2, Tadeja Pintar69 and Elio Jovine22

Author Affiliations

1 Department of Surgery, Macerata Hospital, Macerata, Italy

2 Emergency Surgery, Maggiore Parma Hospital, Parma, Italy

3 Department of General Surgery, Ospedali Riuniti, Bergamo, Italy

4 Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland

5 Department of Surgery, Sisli Florence Nigtingale Hospital, Istanbul, Turkey

6 Department of Surgery, Radboud University Nijmegen Medical Centre Nijmegen, Nijmegen, Netherlands

7 Clinic of Infectious Diseases, Department of Internal Medicine Geriatrics and Nephrologic Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy

8 Department of Neuroscience, UT Southwestern Medical Center, Dallas, USA

9 General, Oncological, Geriatrical Surgery and advanced Technology, University Federico II, Naples, Italy

10 Department of Human Pathology and Oncology, Policlinico le Scotte, University Hospital, Siena, Italy

11 Department of Surgery, Fatebenefratelli Isola Tiberina hospital, Rome, Italy

12 Department of General Surgery, Bakirkoy Training Research Hospital, Istanbul, Turkey

13 Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey

14 Department of Surgery, Parc Tauli University Hospital, Bercelona, Spain

15 Emergency Department, Umberto I, Hospital, Rome, Italy

16 Department of Gastroenterological surgery Turku, University Central Hospital, Turku, Finland

17 Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia

18 Department of General Surgery, First Clinic of General Surgery University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria

19 Departement of Emergency Surgery, Pôle Urgences, CHU de Nice, Université de Nice Sophia-antipolis, Nice, France

20 Department of Surgery, AZ Maria Middelares, Ghent, Belgium

21 3rd Department of Generał Surgery, Narutowicz Hospital, Krakow, Połand

22 Department of Surgery, Maggiore Hospital, Bologna, Italy

23 Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy

24 Department of Surgery, University of Insubria (Chief Renzo Dionigi), Varese, Italy

25 Department GI-surgery, Kuopio University hospital, Kuopio, Finland

26 2nd Department of Surgery, Jagiellonian University Krakow, Krakow, Poland

27 Department of Surgery Hospital, Oncological Centre Novy Jicin, Novy Jicin, Czech Republic

28 Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland

29 Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, CHUV Lausanne, Lausanne, Switzerland

30 Department of General Surgery, Lviv, Emergency hospital, Lviv, Ukraine

31 Center of general surgery, North Estonia Regional Hospital, Tallinn, Estonia

32 Intensive Care Klinikum, Magdeburg gGmbH, Magdeburg, Germany

33 Department of Emergency Surgery, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy

34 Department of Hepato-biliary and Pancreatic surgery and Transplantology, Military Medical Hospital, Sofia, Bulgaria

35 Department of Surgery, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy

36 General and Vascular Surgery, M.Mellini Hospital, Chiari, Italy

37 Department of surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina

38 Department of General and Colorectal Surgery, University Hospital, Central Veterans Hospital, Lodz, Poland

39 Surgical Department, Santa Croce e Carle hospital, Cuneo, Italy

40 Department of Surgery, São Teotónio Hospital, Viseu, Portugal

41 Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom

42 IInd Surgical department of Medical faculty Comenius University, University Hospital Bratislava, st. Cyril and Methodius Hospital Bratislava, Bratislava, Slovakia

43 Department of Surgery, Medical School University of Pécs, Pécs, Hungary

44 Department of Abdominal Surgery, University Clinical Centre of Kosovo, Prishtina, Kosovo

45 2nd Department of Surgery, General Army Hospital of AthensBratislava, Athens, Greece

46 Department of General and Digestive Surgery, Virgen de la Victoria University Hospital, Malaga, Spain

47 Cristian Mesina, Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania

48 Surgical Department, General hospital Jesenice, Jesenice, Slovenia

49 Department of Surgery, Andosilla Hospital, Civita Castellana, Italy

50 General Surgery, Ospedale Civile, Adria, Italy

51 Pietro Coletta Department of Surgery, Jesi Hospital, Jesi, Italy

52 Department of Gastrointestinal Surgery, North Carelian Central Hospital, Joensuu, Finland

53 Oncologic, Digestive and Emergency Surgery, Bocage Hospital, Dijon, France

54 Department of General Surgery, General Hospital of Larissa, Larissa, Greece

55 Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece

56 Surgical Department, Mozyr, Belarus

57 Department of Pediatric Surgery, Paediatric Surgery and Orthopaedic Clinic, Niš, Serbia

58 General Surgery, Clinical Hospital at Chelyabinsk Station OJSC, Russian Railroads, Chelyabinsk City, Russian Federation

59 First Department of Surgery, Tzanion General Hospital, Piraeus, Greece

60 Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania

61 Deparment of Surgery - Downtown Campus, University Hospital of Munich, Munich, Germany

62 General and Emergency surgery, SG Bosco Hospital, Torino, Italy

63 Department of General Surgery, Hospital La Paz Madrid, Madrid, Spain

64 Department of Gynecology and Obstetrics, CHI Poissy Saint Germain en Laye, Poissy, University Versailles Saint-Quentin en Yvelines, Versailles, France

65 Chirurgie Viscerale, Digestive et Oncologique Hospital Prive, Arras les Bonnettes, Arras, France

66 Department of General Surgery, Hospital São João Porto, Porto, Portugal

67 Division of Transplantation, Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece

68 1st Surgical Department, General Regional Hospital, George Papanikolaou, Thessaloniki, Greece

69 Department of Abdominal Surgery, UMC Ljubljana, Ljubljana, Slovenia

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World Journal of Emergency Surgery 2012, 7:15  doi:10.1186/1749-7922-7-15

Published: 21 May 2012


The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).

This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.

Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.

912 patients with a mean age of 54.4 years (range 4–98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.

The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.

White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.