Nationwide observational study of mortality from complicated intra-abdominal infections and the role of bacterial cultures

Tsuchiya, Asuka; Yasunaga, Hideo; Tsutsumi, Yusuke; Kawahara, Takuya; Matsui, Hiroki; Fushimi, Kiyohide

doi:10.1002/bjs.11095

Cited by 9 publications

(6 citation statements)

References 48 publications

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“…However, initial empirical antibiotic therapy is often non-specific, which may lead to unnecessary exposure to broad-spectrum antibiotics, and needs to be adjusted according to the microorganism profile as soon as possible (Mazuski et al, 2002;Thorndike and Kollef, 2020). Furthermore, for sepsis patients with negative cultures, the rapid and accurate identification of pathogens remains a challenge (Tsuchiya et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…For intra-abdominal infection (IAI), culturing peritoneal drainage (PD) fluid is a common method of identifying the pathogen (Mazuski et al, 2002;Tsuchiya et al, 2019;Thorndike and Kollef, 2020). The percentage of positive PD culture in clinical settings varies between 19.5 and 63.7%, (Waele et al, 2014;Sim et al, 2020;Xiong and Rao, 2020) while the microbiological profiles (culture and susceptibility results) often require more than 72 h (Rajapaksha et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Metagenomic Next-Generation Sequencing for the Microbiological Diagnosis of Abdominal Sepsis Patients

Gai²,

Zhang

et al. 2022

Front. Microbiol.

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ObjectivesFor patients with intra-abdominal infection (IAI), the rapid and accurate identification of pathogens remains a challenge. Metagenomic next-generation sequencing (mNGS) is a novel technique for infectious diseases, but its application in IAI is limited. In this study, we compared the microbiological diagnostic ability of plasma mNGS with that of conventional peritoneal drainage (PD) culture in critical care settings.MethodsFrom January 2018 to December 2020, a prospective observational study was performed at a tertiary teaching hospital in China and data on 109 abdominal sepsis patients were collected. The pathogen detection performance of plasma mNGS and PD culture method were compared.Measurements and ResultsNinety-two positive cases detected on PD culture, while plasma mNGS detected 61 positive cases. Forty-five patients (44.0%) had at least one matched pair of plasma mNGS and PD culture results. Compared with PD culture, the plasma mNGS was more rapid (27.1 ± 4.0 vs. 68.9 ± 22.3 h, p < 0.05). The patients received initial antibiotic treatment matched with mNGS detection showed better clinical outcomes.ConclusionFor abdominal sepsis patients, plasma mNGS can provide early, noninvasive, and rapid microbiological diagnosis. Compared with conventional PD smear, culture, and blood culture methods, plasma mNGS promote the rapid detection of pathogenic bacteria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metagenomic Next-Generation Sequencing for the Microbiological Diagnosis of Abdominal Sepsis Patients

Gai²,

Zhang

et al. 2022

Front. Microbiol.

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“…There are no clear recommendations in low-risk patients with community-acquired IAI. An association between taking intra-abdominal cultures and lower mortality in patients with IAI has been reported [ 24 ]. If the patient is deteriorating, clinicians should consider upgrade the antimicrobial treatment, and peritoneal cultures can guide to pathogen-directed therapy with more favorable outcomes.…”

Section: Sepsis Team: the Role In Intra-abdominal Infection And Emerg...mentioning

confidence: 99%

Sepsis Team Organizational Model to Decrease Mortality for Intra-Abdominal Infections: Is Antibiotic Stewardship Enough?

et al. 2022

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Introduction. Sepsis is an overwhelming reaction to infection with significant morbidity, requiring urgent interventions in order to improve outcomes. The 2016 Sepsis-3 guidelines modified the previous definitions of sepsis and septic shock, and proposed some specific diagnostic and therapeutic measures to define the use of fluid resuscitation and antibiotics. However, some open issues still exist. Methods. A literature research was performed on PubMed and Cochrane using the terms “sepsis” AND “intra-abdominal infections” AND (“antibiotic therapy” OR “antibiotic treatment”). The inclusion criteria were management of intra-abdominal infection (IAI) and effects of antibiotic stewardships programs (ASP) on the outcome of the patients. Discussion. Sepsis-3 definitions represent an added value in the understanding of sepsis mechanisms and in the management of the disease. However, some questions are still open, such as the need for an early identification of sepsis. Sepsis management in the context of IAI is particularly challenging and a prompt diagnosis is essential in order to perform a quick treatment (source control and antibiotic treatment). Antibiotic empirical therapy should be based on the kind of infection (community or hospital acquired), local resistances, and patient’s characteristic and comorbidities, and should be adjusted or de-escalated as soon as microbiological information is available. Antibiotic Stewardship Programs (ASP) have demonstrated to improve antimicrobial utilization with reduction of infections, emergence of multi-drug resistant bacteria, and costs. Surgeons should not be alone in the management of IAI but ideally inserted in a sepsis team together with anaesthesiologists, medical physicians, pharmacists, and infectious diseases specialists, meeting periodically to reassess the response to the treatment. Conclusion. The cornerstones of sepsis management are accurate diagnosis, early resuscitation, effective source control, and timely initiation of appropriate antimicrobial therapy. Current evidence shows that optimizing antibiotic use across surgical specialities is imperative to improve outcomes. Ideally every hospital and every emergency surgery department should aim to provide a sepsis team in order to manage IAI.

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“…Rapid and accurate diagnosis of infecting pathogens is essential to optimize clinical management and improve outcome of septic patients [ 2 ]. Intra-abdominal culture and antibiotic susceptibility test may help to ensure effective anti-infective therapy and minimize excessive use of broad-spectrum antibiotics [ 3 ]. However, the sensitivity of peritoneal drainage (PD) culture varies between 19.5 and 63.7% in clinical settings [ 4 , 5 ], moreover conventional culture methods require a certain period of time for examination [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Utility of paired plasma and drainage fluid mNGS in diagnosing acute intra-abdominal infections with sepsis

Mao,

Li,

Zhang

et al. 2024

BMC Infect Dis

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Background Metagenomic next-generation sequencing (mNGS) has been increasingly applied in sepsis. We aimed to evaluate the diagnostic and therapeutic utility of mNGS of paired plasma and peritoneal drainage (PD) fluid samples in comparison to culture-based microbiological tests (CMTs) among critically ill patients with suspected acute intra-abdominal infections (IAIs). Methods We conducted a prospective study from October 2021 to December 2022 enrolling septic patients with suspected IAIs (n = 111). Pairwise CMTs and mNGS of plasma and PD fluid were sent for pathogen detection. The mNGS group underwent therapeutic regimen adjustment based on mNGS results for better treatment. The microbial community structure, clinical features, antibiotic use and prognoses of the patients were analyzed. Results Higher positivity rates were observed with mNGS versus CMTs for both PD fluid (90.0% vs. 48.3%, p < 0.005) and plasma (76.7% vs. 1.6%, p < 0.005). 90% of enrolled patients had clues of suspected pathogens combining mNGS and CMT methods. Gram-negative pathogens consist of most intra-abdominal pathogens, including a great variety of anaerobes represented by Bacteroides and Clostridium. Patients with matched plasma- and PD-mNGS results had higher mortality and sepsis severity. Reduced usage of carbapenem (30.0% vs. 49.4%, p < 0.05) and duration of anti-MRSA treatment (5.1 ± 3.3 vs. 7.0 ± 8.4 days, p < 0.05) was shown in the mNGS group in our study. Conclusions Pairwise plasma and PD fluid mNGS improves microbiological diagnosis compared to CMTs for acute IAI. Combining plasma and PD mNGS could predict poor prognosis. mNGS may enable optimize empirical antibiotic use.

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Nationwide observational study of mortality from complicated intra-abdominal infections and the role of bacterial cultures

Cited by 9 publications

References 48 publications

Metagenomic Next-Generation Sequencing for the Microbiological Diagnosis of Abdominal Sepsis Patients

Metagenomic Next-Generation Sequencing for the Microbiological Diagnosis of Abdominal Sepsis Patients

Sepsis Team Organizational Model to Decrease Mortality for Intra-Abdominal Infections: Is Antibiotic Stewardship Enough?

Utility of paired plasma and drainage fluid mNGS in diagnosing acute intra-abdominal infections with sepsis

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