Compliance with an empirical antimicrobial protocol improves the outcome of complicated intra-abdominal infections: a prospective observational study

Guilbart, Mathieu; Zogheib, Élie; Ntouba, Alexandre; Rebibo, Lionel; Régimbeau, Jean‐Marc; Mahjoub, Yazine; Dupont, Hervé

doi:10.1093/bja/aew117

Cited by 17 publications

(19 citation statements)

References 33 publications

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“…First, inappropriate antibiotic therapy is associated with several adverse outcomes, such as increased postoperative complications, resulting in longer hospital stays and higher care costs. [21][22][23][24][25] Second, adherence to empiric antibiotic prescribing guidelines and stewardship programs helps to reduce the prevalence and avoid emergence of antibiotic-resistant bacteria. [26][27][28][29] Research investigating antibiotic use is extensive, and recent studies continue to show disappointing rates of prophylactic antibiotic use across various patient populations.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use among older adults on an acute care general surgery service

Pollmann

Bailey

Davis³

et al. 2017

CJS

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Background: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital.Methods: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines.Results: During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second-or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion:Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.Contexte : Les antibiotiques jouent un rôle important dans de nombreux cas de chirurgie chez les adultes âgés, et le risque d'utilisation inappropriée de ces médicaments est élevé. Notre objectif était de décrire l'utilisation des antibiotiques chez les patients âgés admis au service chirurgical d'urgence d'un centre hospitalier universitaire de soins tertiaires.Méthodes : Nous avons recueilli de manière rétrospective les données détaillées sur le diagnostic, les comorbidités, la chirurgie et l'utilisation d'antibiotiques chez les patients de 70 ans et plus admis dans un service chirurgical d'urgence. Nous avons évalué le bien-fondé du recours aux antibiotiques (prophylaxie et traitement périopératoire) en fonction des lignes directrices publiées.

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Section: Discussionmentioning

confidence: 99%

Antibiotic use among older adults on an acute care general surgery service

Pollmann

Bailey

Davis³

et al. 2017

CJS

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“…1, 2, 6, 10 Secondary peritonitis with severe sepsis or septic shock have reported an average associated mortality rate of approximately 30%. [15][16][17][18] Tertiary peritonitis is described as a recurrent or persistent infection of the abdominal cavity that lasts more than 48 hours after allegedly successful and appropriate surgical source control of a secondary peritonitis. It occurs more frequently in critically ill or immunocompromised patients, and is repeatedly linked to highly resistant pathogens and high morbidity and mortality.…”

Section: Primary Secondary and Tertiary Peritonitismentioning

confidence: 99%

“…2,4,10,12 Suitable empiric antibiotic therapy has a huge impact on the outcome of patients diagnosed with IAIs. 13,18,20,28,30 IAI can be managed with single or combined antibiotic regimens, determined by the spectrum demands of antibiotic scope. 4 Cultures are strongly recommended, particularly in patients at risk for infection by drug resistant (DR) pathogens, for consequent antibiotic therapy adjustment, aiming at maximizing its effect in the involved pathogens while minimizing selective pressure.…”

Section: Treatment Of Intra-abdominal Infectionsmentioning

confidence: 99%

“…There is evidence that inadequate and/or delayed antibiotic therapy is associated with treatment failure and increased mortality. 2,13,14,18,25,28,30,[45][46][47][48][49] The sensitive equilibrium between the enhancement of empirical antibiotic therapy, which was proved to promote better clinical results, and the decline of needless antimicrobial overuse, which has been linked to the increasing development of MDR pathogens, is invariably needed when treating infections. 10,13,50 Furthermore, needless wide coverage and excessively extended antibiotic therapy is associated with patient-and agent-specific toxicities of therapy, as well as superinfection by…”

Section: Consequences Of Antibiotics Misusementioning

confidence: 99%

“…10,14,31,53,54 It was considered a major public health issue and a danger for the future of healthcare by the World Health Organization (WHO) and the European Community (EC). 18,50,52,[55][56][57] The main promoter of antibiotic resistance is the selective pressure induced by the use of antimicrobials, being the antibiotic overuse in humans and food-producing animals the major causes. 56 Discoveries suggest that 80% of all antimicrobial are intended for food-producing animals, advocating for a better surveillance of agricultural and veterinary practises.…”

Section: Consequences Of Antibiotics Misusementioning

confidence: 99%

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

Nunes

Cardoso

2019

Preprint

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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.

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ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients

et al. 2019

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Compliance with an empirical antimicrobial protocol improves the outcome of complicated intra-abdominal infections: a prospective observational study

Abstract: Non-compliance with empirical ABT guidelines in cIAI is associated with increased morbidity and mortality. Information campaigns should target older anaesthetists and risk factors for MDRB.

Cited by 17 publications

References 33 publications

Antibiotic use among older adults on an acute care general surgery service

Antibiotic use among older adults on an acute care general surgery service

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

ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients

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