Appendicular Versus Non-Appendicular Community-Acquired Intra-Abdominal Infections: A Post-Hoc Analysis of the PERICOM Multicenter Study
Abstract
Background: Community-acquired intra-abdominal infections (CA-IAIs) exhibit significant clinical heterogeneity. However, most studies focusing on CA-IAIs do not stratify comparisons by infection site. Methods: This post hoc analysis of the prospective multicenter PERICOM cohort (13 French university hospitals, April 2018 to February 2019) included adult patients with CA-IAIs requiring surgical management. We compared clinical characteristics, microbiology, and outcomes between appendicular and non-appendicular sites. Secondary analyses assessed the impact of Enterococcus spp., Pseudomonas aeruginosa, or fungal documentation, and the theoretical coverage of empirical antibiotic regimens. Results: Of the 205 patients, 86 (42%) had appendicular and 119 (58%) had non-appendicular CA-IAIs. Appendicular CA-IAIs involved younger patients with fewer comorbidities and were followed by fewer major postoperative complications (Clavien-Dindo score ≥ 3: 10% versus 43%, p < 0.001) and no deaths (0% versus 12%, p < 0.001). Among 118 culture-positive patients, appendicular CA-IAIs showed higher rates of non-fermenting Gram-negative bacilli (25% versus 10%, p = 0.046) and anaerobes (53% versus 28%, p = 0.008) and were more often polymicrobial (76% versus 55%, p = 0.020). Conversely, Staphylococcus spp. (0% versus 9%, p = 0.036) and fungal co-infection (0% versus 12%, p = 0.010) were confined to non-appendicular CA-IAIs. Furthermore, Enterococcus spp. documentation (24/118, 20%) identified patients with greater admission severity and higher 28-day mortality (33% versus 2%, p < 0.001). Amoxicillin-clavulanic acid plus gentamicin covered the isolates of 92% of patients versus 61% for third-generation cephalosporin plus metronidazole (p < 0.001), a difference identical in both appendicular and non-appendicular sites. Conclusions: Appendicular and non-appendicular CA-IAIs appear to be distinct entities, supporting stratified management. Future guidelines should consider site-specific strategies, therapeutic individualization, and the integration of CA-IAI ecology.
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BibTeX
@article{chouaikhiperrois2026appendicular,
title = {{Appendicular Versus Non-Appendicular Community-Acquired Intra-Abdominal Infections: A Post-Hoc Analysis of the PERICOM Multicenter Study}},
author = {Arthur Chouaikhi-Perrois and Nicolas Boulet and Samy Figueiredo and Benjamin Louart and Delphine Garrigue and Guillaume Bouhours and Hervé Dupont and Pierre Bouzat and Jean Bardon and Julien Pottecher and Pierre Michelet and Sébastien Perbet and Katia Aymart and Pascal Incagnoli and Sophie Lloret and Anatole Harrois and Philippe Montravers and Claire Roger},
journal = {Antibiotics},
year = {2026},
month = sep,
doi = {10.3390/antibiotics15090910},
url = {https://u-picardie.hal.science/hal-05757869v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Appendicular Versus Non-Appendicular Community-Acquired Intra-Abdominal Infections: A Post-Hoc Analysis of the PERICOM Multicenter Study
AU - Arthur Chouaikhi-Perrois
AU - Nicolas Boulet
AU - Samy Figueiredo
AU - Benjamin Louart
AU - Delphine Garrigue
AU - Guillaume Bouhours
AU - Hervé Dupont
AU - Pierre Bouzat
AU - Jean Bardon
AU - Julien Pottecher
AU - Pierre Michelet
AU - Sébastien Perbet
AU - Katia Aymart
AU - Pascal Incagnoli
AU - Sophie Lloret
AU - Anatole Harrois
AU - Philippe Montravers
AU - Claire Roger
PY - 2026
DA - 2026/09/16
JO - Antibiotics
DO - 10.3390/antibiotics15090910
UR - https://u-picardie.hal.science/hal-05757869v1
AB - Background: Community-acquired intra-abdominal infections (CA-IAIs) exhibit significant clinical heterogeneity. However, most studies focusing on CA-IAIs do not stratify comparisons by infection site. Methods: This post hoc analysis of the prospective multicenter PERICOM cohort (13 French university hospitals, April 2018 to February 2019) included adult patients with CA-IAIs requiring surgical management. We compared clinical characteristics, microbiology, and outcomes between appendicular and non-appendicular sites. Secondary analyses assessed the impact of Enterococcus spp., Pseudomonas aeruginosa, or fungal documentation, and the theoretical coverage of empirical antibiotic regimens. Results: Of the 205 patients, 86 (42%) had appendicular and 119 (58%) had non-appendicular CA-IAIs. Appendicular CA-IAIs involved younger patients with fewer comorbidities and were followed by fewer major postoperative complications (Clavien-Dindo score ≥ 3: 10% versus 43%, p < 0.001) and no deaths (0% versus 12%, p < 0.001). Among 118 culture-positive patients, appendicular CA-IAIs showed higher rates of non-fermenting Gram-negative bacilli (25% versus 10%, p = 0.046) and anaerobes (53% versus 28%, p = 0.008) and were more often polymicrobial (76% versus 55%, p = 0.020). Conversely, Staphylococcus spp. (0% versus 9%, p = 0.036) and fungal co-infection (0% versus 12%, p = 0.010) were confined to non-appendicular CA-IAIs. Furthermore, Enterococcus spp. documentation (24/118, 20%) identified patients with greater admission severity and higher 28-day mortality (33% versus 2%, p < 0.001). Amoxicillin-clavulanic acid plus gentamicin covered the isolates of 92% of patients versus 61% for third-generation cephalosporin plus metronidazole (p < 0.001), a difference identical in both appendicular and non-appendicular sites. Conclusions: Appendicular and non-appendicular CA-IAIs appear to be distinct entities, supporting stratified management. Future guidelines should consider site-specific strategies, therapeutic individualization, and the integration of CA-IAI ecology.
SN - 2079-6382
ER -