BACKGROUND: Although delay in the administration of appropriate antibiotic treatment for ventilator-associated or community-acquired pneumonia is associated with increased hospital mortality, impact of appropriateness of initial antibiotic therapy on outcome of postoperative pneumonia has been poorly investigated. MATERIALS AND METHODS: Of 7,275 patients who had undergone intraabdominal surgery under general anesthesia between January 1998 and December 2005, we compiled a list of 101 patients with microbiologically confirmed postoperative pneumonia. We analyzed the influence of the appropriateness of initial antibiotic therapy on outcome of postoperative pneumonia using logistic regression analysis. RESULTS: Among the patients with postoperative pneumonia, about a half received inadequate initial antimicrobial therapy. As well as the presence of concomitant intraabdominal abscess [odds ratio (OR) = 28.83), prolonged duration of anesthesia at surgery (OR = 22.41), and the isolation of methicillin-resistant Staphylococcus aureus (OR = 8.86), inadequate initial antibiotic therapy was a determinant of death from postoperative pneumonia (OR = 16.75). CONCLUSION: The outcomes of patients with postoperative pneumonia could be improved by avoiding concomitant intraabdominal abscess, reducing surgical insult, and administering appropriate antimicrobial agents.
BACKGROUND: Although delay in the administration of appropriate antibiotic treatment for ventilator-associated or community-acquired pneumonia is associated with increased hospital mortality, impact of appropriateness of initial antibiotic therapy on outcome of postoperative pneumonia has been poorly investigated. MATERIALS AND METHODS: Of 7,275 patients who had undergone intraabdominal surgery under general anesthesia between January 1998 and December 2005, we compiled a list of 101 patients with microbiologically confirmed postoperative pneumonia. We analyzed the influence of the appropriateness of initial antibiotic therapy on outcome of postoperative pneumonia using logistic regression analysis. RESULTS: Among the patients with postoperative pneumonia, about a half received inadequate initial antimicrobial therapy. As well as the presence of concomitant intraabdominal abscess [odds ratio (OR) = 28.83), prolonged duration of anesthesia at surgery (OR = 22.41), and the isolation of methicillin-resistant Staphylococcus aureus (OR = 8.86), inadequate initial antibiotic therapy was a determinant of death from postoperative pneumonia (OR = 16.75). CONCLUSION: The outcomes of patients with postoperative pneumonia could be improved by avoiding concomitant intraabdominal abscess, reducing surgical insult, and administering appropriate antimicrobial agents.