Bacterial Species-Specific Hospital Mortality Rate for Intra-Abdominal Infections

Claridge, Jeffrey A.; Banerjee, Aman; Kelly, Katherine B.; Leukhardt, William H.; Carter, Jeffrey W.; Haridas, Manjunath; Malangoni, Mark A.

doi:10.1089/sur.2011.039

Cited by 17 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The distribution of isolated pathogens, in our study, was identical to other reports, being Escherichia coli the most frequent, independently of the classification used [5, 15, 21, 39–41]. The prevalence of monomicrobial IAIs (62%) was much superior in comparison to the studies by Claridge et al [41] (41%) and Shah et al [42] (33%).…”

Section: Discussionsupporting

confidence: 86%

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment

Nunes

Cardoso

2019

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundIntra-abdominal infections (IAIs) represent a most frequent gastrointestinal emergency and serious cause of morbimortality. A full classification, including all facets of IAIs, does not exist. Two classifications are used to subdivide IAIs: uncomplicated or complicated, considering infection extent; and community-acquired, healthcare-associated or hospital-acquired, regarding the place of acquisition. Adequacy of initial empirical antibiotic therapy prescribed is an essential need. Inadequate antibiotic therapy is associated with treatment failure and increased mortality. This study was designed to determine accuracy of different classifications of IAIs to identify infections by pathogens sensitive to current treatment guidelines helping the selection of the best antibiotic therapy.MethodsA retrospective cohort study including all adult patients discharged from hospital with a diagnosis of IAI between 1st of January and 31st of October, 2016. All variables potentially associated with pre-defined outcomes: infection by a pathogen sensitive to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (ATB 1, primary outcome), sensitive to piperacillin-tazobactam (ATB 2) and hospital mortality (secondary outcomes) were studied through logistic regression. Accuracy of the models was assessed by area under receiver operating characteristics (AUROC) curve and calibration was tested using the Hosmer-Lemeshow goodness-of-fit test.ResultsOf 1804 patients screened 154 met inclusion criteria. Sensitivity to ATB 1 was independently associated with male gender (adjusted OR = 2.612) and previous invasive procedures in the last year (adjusted OR = 0.424) (AUROC curve = 0,65). Sensitivity to ATB 2 was independently associated with liver disease (adjusted OR = 3.580) and post-operative infections (adjusted OR = 2.944) (AUROC curve = 0.604). Hospital mortality was independently associated with age ≥ 70 (adjusted OR = 4.677), solid tumour (adjusted OR = 3.127) and sensitivity to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (adjusted OR = 0.368).The accuracy of pre-existing classifications to identify infection by a pathogen sensitive to ATB 1 was 0.59 considering place of acquisition, 0.61 infection extent and 0.57 local of infection, for ATB 2 it was 0.66, 0.50 and 0.57, respectively.ConclusionNone of existing classifications had a good discriminating power to identify IAIs caused by pathogens sensitive to current antibiotic treatment recommendations. A new classification, including patients’ individual characteristics like those included in the current model, might have a higher potential to distinguish IAIs by resistant pathogens allowing a better choice of empiric antibiotic therapy.

show abstract

Section: Discussionsupporting

confidence: 86%

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment

Nunes

Cardoso

2019

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…continues to be debated 262728. Some studies have suggested that the isolation of Enterococcus in patients with IAIs results in treatment failure or increased mortality,293031 while others demonstrated no association with mortality 3233. Furthermore, some studies have shown equivalent therapeutic effects among empiric antibiotic regimens, regardless of the antimicrobial activity against enterococci 34353637.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study

et al. 2019

View full text Add to dashboard Cite

Background: This study evaluated the antimicrobial susceptibility of pathogens isolated from Korean patients with intraabdominal infections (IAIs). Methods: This multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems. Results: A total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively. Conclusion: Enterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or J Korean Med Sci. 2019 Dec 9;34(47):e309 https://doi.

show abstract

“…Escherichia coli the most frequent independently of the classification used. 9,20,28,44,64,66 The prevalence of monomicrobial IAIs (62%) was much superior by comparison to the studies by Claridge et al 66 (41%) and Shah et al 67 (33%).…”

Section: Discussionmentioning

confidence: 70%

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment.

Nunes

Cardoso

2019

Preprint

View full text Add to dashboard Cite

Background: Intra-abdominal infections (IAIs) represent a serious cause of morbimortality. A full classification, including all facets of IAIs, does not exist. Two classifications are used to subdivide IAIs: uncomplicated or complicated, considering infection extent; and community-acquired, healthcare-associated or hospital-acquired, regarding the place of acquisition. Inadequate antibiotic therapy is associated with treatment failure and increased mortality. This study was designed to determine accuracy of different classifications of IAIs to identify infections by pathogens sensitive to current treatment guidelines helping the selection of the best antibiotic therapy. Methods: A retrospective cohort study including all adult patients discharged from hospital with a diagnosis of IAI between 1st of January and 31st of October 2016. All variables potentially associated with pre-defined outcomes: infection by a pathogen sensitive to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (ATB 1, primary outcome), sensitive to piperacillin-tazobactam (ATB 2) and hospital mortality (secondary outcomes) were studied through logistic regression. Accuracy of the models was assessed by area under receiver operating characteristics (AUROC) curve and calibration was tested using the Hosmer-Lemeshow goodness-of-fit test. Results: Of 1804 patients screened 154 met inclusion criteria. Sensitivity to ATB 1 was independently associated with male gender (adjusted OR=2.612) and previous invasive procedures in the last year (adjusted OR=0.424) (AUROC curve=0,65). Sensitivity to ATB 2 was independently associated with liver disease (adjusted OR=3.580) and post-operative infections (adjusted OR=2.944) (AUROC curve=0.604). Hospital mortality was independently associated with age≥70 (adjusted OR=4.677), solid tumour (adjusted OR=3.127) and sensitivity to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (adjusted OR=0.368). The accuracy of pre-existing classifications to identify infection by a pathogen sensitive to ATB 1 was 0.59 considering place of acquisition, 0.61 infection extent and 0.57 local of infection, for ATB 2 it was 0.66, 0.50 and 0.57, respectively. Conclusion: None of existing classifications had a good discriminating power to identify IAIs caused by pathogens sensitive to current antibiotic treatment recommendations. A new classification, including patients’ individual characteristics like those included in the current model, might have a higher potential to distinguish IAIs by resistant pathogens allowing a better choice of empiric antibiotic therapy. Keywords: intra-abdominal infections; classification; antibiotic therapy; hospital mortality.

show abstract

Bacterial Species-Specific Hospital Mortality Rate for Intra-Abdominal Infections

Abstract: In addition to age and intrinsic patient factors, the presence of specific bacterial organisms independently predicts death in patients with non-appendiceal IAI.

Cited by 17 publications

References 12 publications

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment

Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study

Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment.

Contact Info

Product

Resources

About