Open Access Open Badges Research article

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Massimo Sartelli1*, Fausto Catena2, Luca Ansaloni3, Ari Leppaniemi4, Korhan Taviloglu5, Harry van Goor6, Pierluigi Viale7, Daniel Vasco Lazzareschi1, Federico Coccolini3, Davide Corbella8, Carlo de Werra9, Daniele Marrelli10, Sergio Colizza11, Rodolfo Scibè1, Halil Alis12, Nurkan Torer13, Salvador Navarro14, Boris Sakakushev15, Damien Massalou16, Goran Augustin17, Marco Catani18, Saila Kauhanen19, Pieter Pletinckx20, Jakub Kenig21, Salomone Di Saverio22, Elio Jovine22, Gianluca Guercioni23, Matej Skrovina24, Rafael Diaz-Nieto25, Alessandro Ferrero26, Stefano Rausei27, Samipetteri Laine28, Piotr Major29, Eliane Angst30, Olivier Pittet31, Ihor Herych32, Ferdinando Agresta33, Nereo Vettoretto34, Elia Poiasina3, Jaan Tepp35, Gunter Weiss36, Giorgio Vasquez37, Nikola Vladov38, Cristian Tranà39, Samir Delibegovic40, Adam Dziki41, Giorgio Giraudo42, Jorge Pereira43, Helen Tzerbinis44, David van Dellen45, Martin Hutan46, Andras Vereczkei47, Avdyl Krasniqi48, Charalampos Seretis49, Cristian Mesina50, Miran Rems51, Fabio Cesare Campanile52, Pietro Coletta53, Mirjami Uotila-Nieminen54, Mario Dente55, Konstantinos Bouliaris56, Konstantinos Lasithiotakis57, Vladimir Khokha58, Dragoljub Zivanovic59, Dmitry Smirnov60, Athanasios Marinis61, Ionut Negoi62, Ludwig Ney63, Roberto Bini64, Miguel Leon65, Sergio Aloia9, Cyrille Huchon66, Radu Moldovanu67, Renato Bessa de Melo68, Dimitrios Giakoustidis69, Orestis Ioannidis70, Michele Cucchi2, Tadeja Pintar71, Zoran Krivokapic72 and Jelena Petrovic72

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, Netherlands

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

8 Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy

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, Barcelona, Spain

15 First General Surgery Clinic, University Hospital St. George/Chair of Surgical Propedeutics, Medical Faculty, Medical University Plovdiv, Plovdic, Bulgaria

16 Department of Emergency Surgery, University Hospital of Nice, University of Nice Sophia-Antipolis, Sophia-Antipolis, France

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

18 Emergency Department, Umberto I Hospital, “La Sapienza” University of Rome, Rome, Italy

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

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 Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech republic

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

26 Department of Surgery, Mauriziano Hospital, Torino, Italy

27 Department of Surgery (Chief Renzo Dionigi), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

28 Department GI-surgery, Kuopio University Hospital, Kuopio, Finland

29 2nd Department of Surgery, Jagiellonian University, Krakow, Poland

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

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

32 Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine

33 Department of General Surgery, Ospedale Civile, Adria (RO), Italy

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

35 First General Surgery, North Estonia Regional Hospital, Tallinn, Estonia

36 Intensive Care Klinikum, Magdeburg gGmbH, Magdeburg, Germany

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

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

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

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

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

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

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

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

45 Department of Surgery, Manchester Royal Infirmare, Manchester, UK

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

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

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

49 2nd Department of Surgery, General Army Hospital of Athens, Athens, Greece

50 Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Roumanie

51 Surgical Department, General hospital Jesenice, Jesenice, Slovenia

52 Department of surgery, Andosilla Hospital, Civita Castellana, Italy

53 Department of Surgery, Jesi Hospital, Jesi, Italy

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

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

56 Surgical Department General Hospital of Larissa, Larissa, Greece

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

58 Surgical Department, Mozyr, Belarus

59 Department of Pediatric surgery, Paediatric surgery and orthopaedic Clinic, Nis, Serbia

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

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

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

63 Deparment of Surgery, Downtown Campus, University Hospital of Munich, Munich, Germany

64 General and emergency surgery, SG Bosco Hospital, Torino, Italy

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

66 Department of Gynecology and Obstetrics, CHI Poissy-St-Germain-En-Laye, France and University Versailles Saint-Quentin, Versailles, France

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

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

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

70 1st Surgical Department, General Regional Hospital "George Papanikolaou", Thessaloniki, Greece

71 Department of Abdominal Surgery, umc Ljubljana, Ljubljana, Slovenia

72 First Surgical clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade 8, Belgrade, Serbia

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World Journal of Emergency Surgery 2012, 7:36  doi:10.1186/1749-7922-7-36

Published: 29 November 2012


The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).

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

2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.

The overall mortality rate was 7.5% (163/2.152).

According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.

Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.