BACKGROUND: We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. METHODS: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ(2) analysis, Wilcoxon rank sum test, and multi-variable analysis. RESULTS: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3 vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). CONCLUSIONS: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.
BACKGROUND: We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. METHODS: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ(2) analysis, Wilcoxon rank sum test, and multi-variable analysis. RESULTS: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3 vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). CONCLUSIONS: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.
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Authors: T C Horan; D H Culver; R P Gaynes; W R Jarvis; J R Edwards; C R Reid Journal: Infect Control Hosp Epidemiol Date: 1993-02 Impact factor: 3.254
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Authors: Massimo Sartelli; Federico Coccolini; Yoram Kluger; Ervis Agastra; Fikri M Abu-Zidan; Ashraf El Sayed Abbas; Luca Ansaloni; Abdulrashid Kayode Adesunkanmi; Boyko Atanasov; Goran Augustin; Miklosh Bala; Oussama Baraket; Suman Baral; Walter L Biffl; Marja A Boermeester; Marco Ceresoli; Elisabetta Cerutti; Osvaldo Chiara; Enrico Cicuttin; Massimo Chiarugi; Raul Coimbra; Elif Colak; Daniela Corsi; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Nicola De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Stijn W de Jonge; Sameer Dhingra; Stefano Di Bella; Francesco Di Marzo; Salomone Di Saverio; Agron Dogjani; Therese M Duane; Mushira Abdulaziz Enani; Paola Fugazzola; Joseph M Galante; Mahir Gachabayov; Wagih Ghnnam; George Gkiokas; Carlos Augusto Gomes; Ewen A Griffiths; Timothy C Hardcastle; Andreas Hecker; Torsten Herzog; Syed Mohammad Umar Kabir; Aleksandar Karamarkovic; Vladimir Khokha; Peter K Kim; Jae Il Kim; Andrew W Kirkpatrick; Victor Kong; Renol M Koshy; Igor A Kryvoruchko; Kenji Inaba; Arda Isik; Katia Iskandar; Rao Ivatury; Francesco M Labricciosa; Yeong Yeh Lee; Ari Leppäniemi; Andrey Litvin; Davide Luppi; Gustavo M Machain; Ronald V Maier; Athanasios Marinis; Cristina Marmorale; Sanjay Marwah; Cristian Mesina; Ernest E Moore; Frederick A Moore; Ionut Negoi; Iyiade Olaoye; Carlos A Ordoñez; Mouaqit Ouadii; Andrew B Peitzman; Gennaro Perrone; Manos Pikoulis; Tadeja Pintar; Giuseppe Pipitone; Mauro Podda; Kemal Raşa; Julival Ribeiro; Gabriel Rodrigues; Ines Rubio-Perez; Ibrahima Sall; Norio Sato; Robert G Sawyer; Helmut Segovia Lohse; Gabriele Sganga; Vishal G Shelat; Ian Stephens; Michael Sugrue; Antonio Tarasconi; Joel Noutakdie Tochie; Matti Tolonen; Gia Tomadze; Jan Ulrych; Andras Vereczkei; Bruno Viaggi; Chiara Gurioli; Claudio Casella; Leonardo Pagani; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-25 Impact factor: 5.469