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De Waele JJ, Coccolini F, Lagunes L, Maseda E, Rausei S, Rubio-Perez I, Theodorakopoulou M, Arvanti K. Optimized Treatment of Nosocomial Peritonitis. Antibiotics (Basel) 2023; 12:1711. [PMID: 38136745 PMCID: PMC10740749 DOI: 10.3390/antibiotics12121711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review aims to provide a practical guide for intensivists, focusing on enhancing patient care associated with nosocomial peritonitis (NP). It explores the epidemiology, diagnosis, and management of NP, a significant contributor to the mortality of surgical patients worldwide. NP is, per definition, a hospital-acquired condition and a consequence of gastrointestinal surgery or a complication of other diseases. NP, one of the most prevalent causes of sepsis in surgical Intensive Care Units (ICUs), is often associated with multi-drug resistant (MDR) bacteria and high mortality rates. Early clinical suspicion and the utilization of various diagnostic tools like biomarkers and imaging are of great importance. Microbiology is often complex, with antimicrobial resistance escalating in many parts of the world. Fungal peritonitis and its risk factors, diagnostic hurdles, and effective management approaches are particularly relevant in patients with NP. Contemporary antimicrobial strategies for treating NP are discussed, including drug resistance challenges and empirical antibiotic regimens. The importance of source control in intra-abdominal infection management, including surgical and non-surgical interventions, is also emphasized. A deeper exploration into the role of open abdomen treatment as a potential option for selected patients is proposed, indicating an area for further investigation. This review underscores the need for more research to advance the best treatment strategies for NP.
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Affiliation(s)
- Jan J. De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Leonel Lagunes
- Vall d’Hebron Institut de Recerca CRIPS, 08035 Barcelona, Spain;
- Facultad de Medicina, Universidad Autónoma de San Luis Potosi, 78210 San Luis Potosi, Mexico
| | - Emilio Maseda
- Department of Anesthesia and Critical Care, Hospital Quironsalud Valle del Henares, 28850 Madrid, Spain;
- Department of Pharmacology and Toxicology, Complutense University of Madrid, 28040 Madrid, Spain
| | - Stefano Rausei
- General Surgery Unit, Department of Surgery, Cittiglio-Angera Hospital, ASST SetteLaghi, 21100 Varese, Italy;
| | - Ines Rubio-Perez
- Colorectal Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, 28029 Madrid, Spain;
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
- Universidad Autonoma de Madrid, 28029 Madrid, Spain
| | - Maria Theodorakopoulou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10675 Athens, Greece;
| | - Kostoula Arvanti
- Department of Intensive Care Medicine, Papageorgiou Hospital, 54646 Thessaloniki, Greece;
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López GAM, Rodríguez LFC, Fandiño LCS, Lasso AD, Granados JPA, Salazar YID, Pereira KA, Velásquez JP, Luna JAC, Trujillo CHS. Effectiveness of Five Antibiotic Regimens for the Treatment of Intra-Abdominal Infection in Bogotá. Surg Infect (Larchmt) 2022; 23:933-939. [PMID: 36472509 DOI: 10.1089/sur.2022.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Intra-abdominal infection (IAI) results in prolonged in-hospital length-of-stay, critical care unit requirements, and multiple surgical procedures. Several antimicrobial agents are available for treatment of IAI. In Colombia, there are no data on the comparative effectiveness of the different regimens used. Patients and Methods: A multicenter retrospective cohort study was completed in four third-level hospitals by comparing treatment effectiveness of five different antibiotic protocols (ampicillin-sulbactam, clindamycin-amikacin, piperacillin-tazobactam, amikacin-metronidazole, and cefuroxime-metronidazole) in patients with a diagnosis of IAI. Analysis was based on a composed outcome of therapeutic failure (change of antibiotic because of no clinical improvement, requirement of surgical re-intervention, post-operative infection, change of antibiotic because of antimicrobial resistance, and in-hospital mortality). Association of each antibiotic protocol to therapeutic failure was assessed through logistic regression analysis. Results: Five hundred ninety-three individuals were included. Two hundred twenty-nine were prescribed ampicillin-sulbactam; 170, clindamycin-amikacin; 77, amikacin-metronidazole; 83, piperacillin-tazobactam; and 34, cefuroxime-metronidazole. Therapeutic failure rate was 22%. Multivariable analysis showed none of the evaluated antibiotic protocols had an association with the primary outcome. Variables having an association for higher risk were age >70 years old (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.04-4.18); complicated IAI (OR, 3.36; 95% CI, 1.4-8.07); and World Society of Emergency Surgery (WSES) Sepsis Severity Score (OR, 1.31; 95% CI, 1.18-1.45). Adequate source control (OR, 0.16; 95% CI, 0.05-0.45) and hospitalization at Health Center 2 (OR, 0.30; 95% CI, 0.14-0.63) were identified as protective factors. Conclusions: There are no differences between the rate of therapeutic failure among the different antibiotic protocols evaluated. This outcome depends heavily on risk factors related to disease severity when surgical intervention occurs.
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Yasin NA, Ali AM, Ahmed MA, Keleşoğlu Sİ. Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia. Int J Gen Med 2022; 15:7427-7434. [PMID: 36172084 PMCID: PMC9512019 DOI: 10.2147/ijgm.s379711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Intra-abdominal infections (IAIs) are common surgical emergencies and one of the leading causes of non-trauma deaths in hospitals worldwide. Because of limited resources, most patients in low-income countries experience delayed diagnosis and treatment. To the best of our knowledge, this is the first study to evaluate the epidemiological characteristics, antimicrobial susceptibility profile, and outcome of patients with complicated IAI at a tertiary hospital in Somalia. Methods This study included all patients with confirmed IAIs who underwent laparotomy or percutaneous drainage, either emergency or elective, and whose cultures showed growth. Sociodemographic and clinical characteristics, culture results, antimicrobial susceptibility profile, and the type of source control were reviewed. Results The prevalence of CIAI was 5.3%, 144 (70%) were male, and 61 (30%) were female. The mean age was 38.6±8.5 years. Appendicitis was the most common source of infection, accounting for 32%, followed by bowel perforation in 37 (18%). Out of 15 patients with liver abscesses, ten patients had diabetes (67%). E. coli 82 (40%) was the most common isolated organism, followed by Klebsiella pneumonia (n = 44, 21.5%). The prevalence of extended-spectrum beta-lactamase-producing and multidrug-resistant pathogens was 6.8% and 5.9%, respectively. The pathogens revealed a higher antimicrobial resistance against penicillins in 62%, cephalosporins in 54%, and fluoroquinolones in 44%. E. coli showed 2.5–13% antimicrobial resistance against carbapenems, lower than Klebsiella pneumonia in about 4.5%. Tigecycline, teicoplanin, and linezolid revealed the highest sensitivity against pathogens, about 100%. Source control was achieved by laparotomy in 81%, while the 19% were managed in a percutaneous approach. The mortality rate in our study was 9.3%. Conclusion The prevalence of CIAI in our study was 5.3%, with an increasing number of MDR microorganisms isolated from cultures. CIAI and intra-abdominal abscess are significant sources of high morbidity and mortality with sepsis and poor clinical outcome; thus, early detection and intervention are crucial.
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Affiliation(s)
- Nor Abdi Yasin
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Nor Abdi Yasin, Tel +252 615732173, Email
| | - Abdihamid Mohamed Ali
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Abdi Ahmed
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Salim İdris Keleşoğlu
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Time to source control and outcome in community-acquired intra-abdominal infections: The multicentre observational PERICOM study. Ugeskr Laeger 2022; 39:540-548. [PMID: 35608877 DOI: 10.1097/eja.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment. OBJECTIVE To describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes. DESIGN A prospective, multicentre, observational study. SETTING Thirteen teaching hospitals in France between April 2018 and February 2019. PATIENTS Two hundred and five patients aged at least 18 years diagnosed with community-acquired IAI. MAIN OUTCOME MEASURES The primary outcome was hospital length of stay. The secondary outcome was hospital mortality. RESULTS Patients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality. CONCLUSION This multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated. STUDY REGISTRATION ClinicalTrials.gov on 1 April 2018, NCT03544203.
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Ahmed S, Bonnett L, Melhuish A, Adil MT, Aggarwal I, Ali W, Bennett J, Boldock E, Burns FA, Czarniak E, Dennis R, Flower B, Fok R, Goodman AL, Halai S, Hanna T, Hashem M, Hodgson SH, Hughes G, Hurndall KH, Hyland R, Iqbal MR, Jarchow-MacDonald A, Kailavasan M, Klimovskij M, Laliotis A, Lambourne J, Lawday S, Lee F, Lindsey B, Lund JN, Mabayoje DA, Malik KI, Muir A, Narula HS, Ofor U, Parsons H, Pavelle T, Prescott K, Rajgopal A, Roy I, Sagar J, Scarborough C, Shaikh S, Smart CJ, Snape S, Tabaqchali MA, Tennakoon A, Tilley R, Vink E, White L, Burke D, Kirby A. Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection. Br J Surg 2021; 108:441-447. [PMID: 33615351 DOI: 10.1093/bjs/znaa117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
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Affiliation(s)
- S Ahmed
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - A Melhuish
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M T Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - I Aggarwal
- Infection Unit, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - W Ali
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - J Bennett
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK
| | - E Boldock
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - F A Burns
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Czarniak
- Department of Microbiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - R Dennis
- Colorectal Surgery Department, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - B Flower
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - R Fok
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - S Halai
- Department of Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - T Hanna
- Department of Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Hashem
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - S H Hodgson
- Department of Infection, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - G Hughes
- Infectious Diseases and Microbiology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - K-H Hurndall
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - R Hyland
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M R Iqbal
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | | | - M Kailavasan
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Klimovskij
- Department of Surgery, Conquest Hospital, East Sussex NHS Healthcare Trust, East Sussex, UK
| | - A Laliotis
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK
| | - J Lambourne
- Division of Infection, Barts Health NHS Trust, London, UK
| | - S Lawday
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - F Lee
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Lindsey
- Department of Microbiology, The Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - J N Lund
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - D A Mabayoje
- Division of Infection, Barts Health NHS Trust, London, UK
| | - K I Malik
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Muir
- Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - H S Narula
- Department of Surgery, Chesterfield Royal Hospital NHS Trust Hospital, Chesterfield, UK
| | - U Ofor
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - H Parsons
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - T Pavelle
- Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - K Prescott
- Microbiology and Infectious Diseases, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rajgopal
- Department of Microbiology, Calderdale and Huddersfield NHS Trust, Huddersfield, UK
| | - I Roy
- Colorectal Surgery Department, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - J Sagar
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - C Scarborough
- Department of Infection, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - S Shaikh
- Department of Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - C J Smart
- Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Cheshire, UK
| | - S Snape
- Microbiology and Infectious Diseases, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M A Tabaqchali
- Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
| | - A Tennakoon
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - R Tilley
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - L White
- Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - D Burke
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
| | - A Kirby
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
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Huang S, Chen L, Liu J, Zhang S, Zhang L, Wen Z, Chen Y, Chen D. Novel Multiparametric Nomogram for Overall Survival Prediction in Complicated Intra-Abdominal Infection: A Multicenter Study in China. Front Med (Lausanne) 2021; 8:627416. [PMID: 33732717 PMCID: PMC7957962 DOI: 10.3389/fmed.2021.627416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Complicated intra-abdominal infections (cIAIs) in the abdominal cavity or within an abdominal organ are numerous and frequent dangerous entities in the treatment of critically ill patients. Early clinical evaluation is necessary. Methods: This retrospective multicenter study included patients from 10 intensive care units (ICUs). Risk factors for the overall survival (OS) of patients with cIAI were selected using least absolute shrinkage and selection operator regression, and a nomogram was constructed subsequently. Calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discriminative ability. Results: In total, 544 patients diagnosed with cIAI were enrolled and divided into the study (n = 276) and validation (n = 268) sets. Sex, acute gastrointestinal injury, acute kidney injury, rare bacterium infection, Charlson score, and APACHE II score were identified as independent risk factors and were constructed for the nomogram. The nomogram showed marked calibration capability with a concordance index (C-index) of 0.909 and 0.831 in the study and validation set, respectively. Compared with the common clinical prognostic scoring system, the nomogram achieved the highest discrimination ability with an area under the curve (AUC) value of 0.91 and 0.83 in the study set and validation set, respectively. Conclusions: Our newly constructed nomogram provides a useful tool for risk stratification and prognosis evaluation of cIAI.
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Affiliation(s)
- Sisi Huang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lidi Zhang
- Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenliang Wen
- Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yizhu Chen
- Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Frühe Optimierung der Antibiotikatherapie durch den schnellen Nachweis von Erregern und Empfindlichkeit. Med Klin Intensivmed Notfmed 2020; 115:420-427. [DOI: 10.1007/s00063-020-00680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/06/2019] [Accepted: 03/08/2020] [Indexed: 11/25/2022]
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Wilke M, Hübner C, Kämmerer W. Calculated parenteral initial treatment of bacterial infections: Economic aspects of antibiotic treatment. GMS INFECTIOUS DISEASES 2020; 8:Doc03. [PMID: 32373428 PMCID: PMC7186923 DOI: 10.3205/id000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the seventeenth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. This chapter analyses economic aspects of antiinfective therapy. Any treatment decision is also a cost decision. In this chapter the authors particularly analyse whether or not there is evidence that certain clinically effective strategies as Antimicrobial Stewardship programs (AMS), guideline adherent initial therapy, early diagnostics, De-escalation, sequence therapy or therapeutic drug monitoring also have benficial economic effects. These can be direct savings or shortening of length of stay to free resources.
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Affiliation(s)
| | - Claudia Hübner
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Universität Greifswald, Germany
| | - Wolfgang Kämmerer
- Klinische Pharmazie, Apotheke des Universitätsklinikums Augsburg, Germany
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Solomkin JS, Sway A, Lawrence K, Olesky M, Izmailyan S, Tsai L. Eravacycline: a new treatment option for complicated intra-abdominal infections in the age of multidrug resistance. Future Microbiol 2019; 14:1293-1308. [DOI: 10.2217/fmb-2019-0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Recently approved for use in complicated intra-abdominal infection, eravacycline is a novel fluorocycline with broad spectrum of activity against resistant Gram-negative pathogens. This manuscript is a pooled analysis of two Phase III trials. Clinical efficacy: Clinical cure rates were 86.8% for eravacycline versus 87.6% for ertapenem, and 90.8% for eravacycline versus 91.2% for meropenem in the Intent to Treat (micro-ITT) populations, and 87.0% for eravacycline versus 88.8% ertapenem, and 92.4 versus 91.6% for meropenem in the Modified Intent to Treat (MITT) populations. Safety: Eravacycline is well tolerated, with lower rates of nausea, vomiting and diarrhea than other tetracyclines. Conclusion: Eravacycline is an effective new option for use in complicated intra-abdominal infections, and in particular, for the treatment of extended-spectrum β-lactamase- and carbapenem-resistant Enterobacteriaceae-expressing organisms.
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Affiliation(s)
- Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, 6005 Given Road Cincinnati, OH 45243, USA
| | - Angie Sway
- Medical Writing, World Surgical Infection Society, Cincinnati, OH 45243, USA
| | - Kenneth Lawrence
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Melanie Olesky
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Sergey Izmailyan
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
| | - Larry Tsai
- Medical Affairs, Tetraphase Pharmaceuticals, Watertown, MA 02472, USA
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10
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Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality. PLoS One 2019; 14:e0223092. [PMID: 31557256 PMCID: PMC6762167 DOI: 10.1371/journal.pone.0223092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/15/2019] [Indexed: 01/29/2023] Open
Abstract
The concept of healthcare-associated infections (as opposed to hospital-acquired infections) in intraabdominal infections (IAIs) is scarcely supported by data in the literature. The aim of the present study was to analyse community-onset IAIs (non-postoperative/non-nosocomial) in patients admitted to intensive care units (ICUs), to investigate differences in resistance patterns linked to healthcare exposure and mortality-associated factors. A one-year prospective observational study (17 Spanish ICUs) was performed distributing cases as healthcare-associated infections (HCAI), community-acquired infections (CAI) and immunocompromised patients (ICP). Bacteria producing extended-spectrum β-lactamases (ESBL) and/or carbapenemase (CPE), high-level aminoglycoside- and/or methicillin- and/or vancomycin- resistance were considered antimicrobial resistant (AMR). Mortality-associated factors were identified by regression multivariate analysis. Of 345 patients included (18.8% HCAI, 6.1% ICP, 75.1% CAI), 51.6% presented generalized peritonitis; 32.5% were >75 years (55.4% among HCAI). Overall, 11.0% cases presented AMR (7.0% ESBL- and/or CPE), being significantly higher in HCAI (35.4%) vs. CAI (5.8%) (p<0.001) vs. ICP (0%) (p = 0.003). Overall 30-day mortality was 14.5%: 23.1% for HCAI and 11.6% for CAI (p = 0.016). Mortality (R2 = 0.262, p = 0.021) was positively associated with age >75 years (OR = 6.67, 95%CI = 2.56-17.36,p<0.001), Candida isolation (OR = 3.05, 95%CI = 1.18-7.87,p = 0.022), and SAPS II (per-point, OR = 1.08, 95%CI = 1.05-1.11, p<0.001) and negatively with biliary infections (OR = 0.06, 95%CI = 0.01-0.48,p = 0.008). In this study, the antimicrobial susceptibility pattern of bacteria isolated from patients with healthcare contact was shifted to resistance, suggesting the need for consideration of the healthcare category (not including hospital-acquired infections) for severe IAIs. 30-day mortality was positively related with age >75 years, severity and Candida isolation but not with AMR.
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11
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Righolt CH, Lagace-Wiens P, Mahmud SM. Prevalence, predictors, and consequences of inappropriate empiric antimicrobial therapy for complicated urinary tract and intra-abdominal infections in Winnipeg hospitals. Diagn Microbiol Infect Dis 2019; 96:114891. [PMID: 31668828 DOI: 10.1016/j.diagmicrobio.2019.114891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
Information on inappropriate empiric antimicrobial therapy (ET) in Canadian hospitals is scarce. All Manitobans 18 years of age and over who were admitted to a hospital in Winnipeg with a complicated urinary tract infection (cUTI) or complicated intra-abdominal infection (cIAI) from January 2006 to December 2014 were eligible for inclusion in this cohort study. The prevalence of inappropriate ET was 11% for cUTI patients and 9% for cIAI patients. The risk of receiving inappropriate ET was higher for older patients (cUTI patients 65 or older had 2-fold increased risk compared to younger patients; odds ratio 2.1, 95% confidence interval 1.3-3.6; this was 1.6 [0.7-3.5] for cIAI patients) and those hospitalized in the previous year: 1.5 (1.0-2.4) in cUTIs and 1.5 (0.6-3.4) in cIAIs. The risk for a hospital stay over 3 weeks was increased for inappropriate ET in cUTI patients, 2.3 (1.4-3.7), but not in cIAI patients, 0.9 (0.4-2.1).
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Philippe Lagace-Wiens
- Diagnostic Services, Shared Health, Clinical Microbiology, Saint-Boniface Hospital, L4025-409 Taché Avenue, Winnipeg, MB, R2H 2A6
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
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12
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Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients. J Crit Care 2018; 50:169-176. [PMID: 30553184 DOI: 10.1016/j.jcrc.2018.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs). METHODS Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections. RESULTS 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04). CONCLUSIONS IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.
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Rickard J, Ngarambe C, Ndayizeye L, Smart B, Riviello R, Majyambere JP, Ghebre RG. Antibiotic Use and Antimicrobial Resistance of Surgical Patients with Peritonitis at a Tertiary Referral Hospital in Rwanda. Surg Infect (Larchmt) 2018; 19:382-387. [PMID: 29621001 DOI: 10.1089/sur.2017.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is growing recognition of the worsening problem of antibiotic resistance and the need for antibiotic stewardship in low-resource settings. The aim of this study was to describe antibiotic use and antimicrobial resistance in patients undergoing surgery for peritonitis at a Rwandan referral hospital. PATIENTS AND METHODS All surgical patients with peritonitis at a Rwandan referral hospital were enrolled. Prospective data were collected on epidemiology, clinical features, interventions, and outcomes. Antibiotic agents were prescribed and cultures were collected according to surgeon discretion. High risk for antibiotic treatment failure or death was defined as patients with severe sepsis, older than 70 years of age, tumor, or operating room delay more than 24 hours from hospital admission. Logistic regression was used to determine factors associated with high risk of antibiotic treatment failure or death. RESULTS Over a six-month period, 280 patients underwent operation for peritonitis; 79 patients were excluded because no infectious etiology was identified at operation. Data on antibiotic usage were available for 165 patients. The most common diagnoses were intestinal obstruction (n = 43) and appendicitis (n = 36). Most patients received antibiotic agents, the most of of which being third-generation cephalosporins (n = 149; 90%) and metronidazole (n = 140; 85%). The mean duration of antibiotics was 5.1 days (range: 0-14). Overall, 80 (54%) patients were high-risk for antibiotic treatment failure or death. Risk for antibiotic treatment failure or death was associated with localized peritonitis (p = 0.001) and high American Society of Anesthesiologist score (p = 0.003). Cultures were collected from 33 patients and seven patients had an organism isolated. Escherichia coli was identified in in five surgical specimens and two 2 urine cultures. All Escherichia coli specimens showed resistance to cephalosporins. CONCLUSIONS Broad antibiotic coverage with third-generation cephalosporins and metronidazole is common in Rwandan surgical patients with peritonitis. Areas for improvement should focus on choice and duration of antibiotic agents, tailored to underlying diagnosis and risk factors for antibiotic treatment failure or death. More data are needed on antibiotic resistance patterns to guide antimicrobial therapy.
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Affiliation(s)
- Jennifer Rickard
- 1 University Teaching Hospital of Kigali , Kigali, Rwanda .,2 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.,3 Human Resources for Health , Rwanda
| | - Christian Ngarambe
- 4 Department of Surgery, University Teaching Hospital of Butare , Department of Surgery, Mamba, Butare, Rwanda
| | - Leonard Ndayizeye
- 4 Department of Surgery, University Teaching Hospital of Butare , Department of Surgery, Mamba, Butare, Rwanda
| | - Blair Smart
- 5 Department of Surgery, University of Southern California , Los Angeles, California
| | - Robert Riviello
- 3 Human Resources for Health , Rwanda .,6 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts
| | | | - Rahel G Ghebre
- 3 Human Resources for Health , Rwanda .,8 Department of Obstetrics Gynecology and Women's Health, University of Minnesota , Minneapolis, Minnesota.,9 School of Medicine, Yale University , New Haven, Connecticut
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14
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Zhen X, Li Y, Chen Y, Dong P, Liu S, Dong H. Effect of multiple drug resistance on total medical costs among patients with intra-abdominal infections in China. PLoS One 2018; 13:e0193977. [PMID: 29590138 PMCID: PMC5873998 DOI: 10.1371/journal.pone.0193977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Multiple drug resistant (MDR) intra-abdominal infections (IAIs) are associated with notable direct and societal costs. As previous studies have not considered the impact of MDR on the total medical costs (TMCs) of IAIs, the present one examines this, as well as further estimates the additional costs at a national level. Methods This is a retrospective study. Firstly, we randomly selected a sample of 40% of all inpatients discharged between 2014 and 2015 from a teaching hospital, due to limits in budget and the large number of patients. Then, we manually selected 254 patients with IAIs according to the International Classification of Disease, 10th revision, using electronic medical records. Eventually, 101 patients with IAIs (64 MDR patients and 37 non-MDR patients) were included after excluding cases without laboratory test results, any pathogens detected, or antimicrobial resistant pathogens. Univariate analysis and a generalized linear model were applied to assess the parameters associated with TMCs. Results Compared to non-MDR patients, those with MDR pathogens were significantly associated with higher TMCs, higher antimicrobial costs, higher antimicrobial usage, larger number of pathogens, and longer length of stay and were more likely to have insurance and combination antimicrobial therapy. In addition, the average TMC among patients with MDR pathogens was ¥ 131801, which is ¥ 90201 higher than those without MDR pathogens. If our results are applied to the whole country, the sum of all attributable TMCs was ¥ 37 billion. The societal costs, furthermore, were ¥111 billion in 2015. Conclusion Our results provide information that should lead to increased efforts to reduce inappropriate antimicrobial therapy, in order to decrease the emergence of MDR pathogens and to reduce their economic burden.
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Affiliation(s)
- Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yuanyuan Li
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yixi Chen
- Pfizer Investment Co. Ltd., Beijing, China
| | - Peng Dong
- Pfizer Investment Co. Ltd., Beijing, China
| | - Stephanie Liu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
- * E-mail:
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Chen M, Zhang M, Huang P, Lin Q, Sun C, Zeng H, Deng Y. Novel β-lactam/β-lactamase inhibitors versus alternative antibiotics for the treatment of complicated intra-abdominal infection and complicated urinary tract infection: a meta-analysis of randomized controlled trials. Expert Rev Anti Infect Ther 2018; 16:111-120. [PMID: 29343141 DOI: 10.1080/14787210.2018.1429912] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/16/2018] [Indexed: 02/05/2023]
Abstract
The aim of this study is to compare the efficacy and safety of novelBL/BLIs with alternative antibiotics for the treatment of cIAI and cUTI. Area covered: We performed a systematic review and meta-analysis of all randomized controlled trials comparing novel BL/BLIs with other antibiotics for the treatment of cIAI and cUTI. The primary outcome included clinical and microbiological treatment success. Expert commentary: We found that novel BL/BLIs obtained a similar clinical outcome with other antibiotics in CE population (OR = 1.07, 95%CI = (0.80, 1.44), P = 0.64). However, novel BL/BLIs had better clinical treatment success in the cUTI subgroup (OR = 2.14, 95%CI = (1.06, 4.31), P = 0.03). Furthermore, novel BL/BLIs achieved significant microbiological treatment success in patie nts with cUTI (OR = 1.70, 95%CI = (1.29, 2.25), P = 0.0002) and had higher eradication rates for Gram-negative pathogens (OR = 1.82, 95%CI = (1.26, 2.64), P = 0.001) including E.coli and K.pneumoniae. No difference was observed concerning the incidence of mortality and adverse events between the two groups. Therefore, we concluded that novel BL/BLIs are not inferior to other available antibiotics for the treatment of cIAI, and they have advantages in patients with cUTI. Simultaneously, they are sensitive to Gram-negative pathogens, especially for E.coli and K.pneumoniae.
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Affiliation(s)
- Mengmeng Chen
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
- b Shantou University Medical College , Shantou , Guangdong , PR China
| | - Minjie Zhang
- c Department of Critical Care Medicine , Jinan University First Affiliated Hospital , Guangzhou , Guangdong , PR China
| | - Peixian Huang
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
- b Shantou University Medical College , Shantou , Guangdong , PR China
| | - Qiongyu Lin
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
| | - Cheng Sun
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
| | - Hongke Zeng
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
| | - Yiyu Deng
- a Department of Critical Care Medicine and Emergency , Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , PR China
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White BP, Wagner JL, Barber KE, King ST, Stover KR. Risk Factors for Failure in Complicated Intraabdominal Infections. South Med J 2018; 111:125-132. [DOI: 10.14423/smj.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Zhang H, Yang Q, Liao K, Ni Y, Yu Y, Hu B, Sun Z, Huang W, Wang Y, Wu A, Feng X, Luo Y, Chu Y, Chen S, Cao B, Su J, Duan Q, Zhang S, Shao H, Kong H, Gui B, Hu Z, Badal R, Xu Y. Update of incidence and antimicrobial susceptibility trends of Escherichia coli and Klebsiella pneumoniae isolates from Chinese intra-abdominal infection patients. BMC Infect Dis 2017; 17:776. [PMID: 29254478 PMCID: PMC5735800 DOI: 10.1186/s12879-017-2873-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate in vitro susceptibilities of aerobic and facultative Gram-negative bacterial (GNB) isolates from intra-abdominal infections (IAIs) to 12 selected antimicrobials in Chinese hospitals from 2012 to 2014. Methods Hospital acquired (HA) and community acquired (CA) IAIs were collected from 21 centers in 16 Chinese cities. Extended spectrum beta-lactamase (ESBL) status and antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. Results From all isolated strains the Enterobacteriaceae (81.1%) Escherichia coli accounted for 45.4% and Klebsiella pneumoniae for 20.1%, followed by Enterobacter cloacae (5.2%), Proteus mirabilis (2.1%), Citrobacter freundii (1.8%), Enterobacter aerogenes (1.8%), Klebsiella oxytoca (1.4%), Morganella morganii (1.2%), Serratia marcescens (0.7%), Citrobacter koseri (0.3%), Proteus vulgaris (0.3%) and others (1.0%). Non- Enterobacteriaceae (18.9%) included Pseudomonas aeruginosa (9.8%), Acinetobacter baumannii (6.7%), Stenotrophomonas maltophilia (0.9%), Aeromonas hydrophila (0.4%) and others (1.1%). ESBL-screen positive Escherichia coli isolates (ESBL+) showed a decreasing trend from 67.5% in 2012 to 58.9% in 2014 of all Escherichia coli isolates and the percentage of ESBL+ Klebsiella pneumoniae isolates also decreased from 2012 through 2014 (40.4% to 26.6%), which was due to reduced percentages of ESBL+ isolates in HA IAIs for both bacteria. The overall susceptibilities of all 5160 IAI isolates were 87.53% to amikacin (AMK), 78.12% to piperacillin-tazobactam (TZP) 81.41% to imipenem (IMP) and 73.12% to ertapenem (ETP). The susceptibility of ESBL-screen positive Escherichia coli strains was 96.77%–98.8% to IPM, 91.26%–93.16% to ETP, 89.48%–92.75% to AMK and 84.86%–89.34% to TZP, while ESBL-screen positive Klebsiella pneumoniae strains were 70.56%–80.15% susceptible to ETP, 80.0%–87.5% to IPM, 83.82%–87.06% to AMK and 63.53%–68.38% to TZP within the three year study. Susceptibilities to all cephalosporins and fluoroquinolones were less than 50% beside 66.5% and 56.07% to cefoxitin (FOX) for ESBL+ Escherichia coli and Klebsiella pneumoniae strains respectively. Conclusions The total ESBL+ rates decreased in Escherichia coli and Klebsiella pneumoniae IAI isolates due to fewer prevalence in HA infections. IPM, ETP and AMK were the most effective antimicrobials against ESBL+ Escherichia coli and Klebsiella pneumoniae IAI isolates in 2012–2014 and a change of fluoroquinolone regimens for Chinese IAIs is recommended. Electronic supplementary material The online version of this article (10.1186/s12879-017-2873-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Zhang
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Qiwen Yang
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Kang Liao
- Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yuxing Ni
- Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Yunsong Yu
- Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Bijie Hu
- Division of Microbiology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenxiang Huang
- Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xianju Feng
- Division of Microbiology, The First Affiliated Hospital of Zhengzhou University, Zhenzhou, 450052, China
| | - Yanping Luo
- Department of Microbiology, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Yunzhuo Chu
- Division of Microbiology, The First Affiliated Hospital of Chinese Medical University, Shenyang, 110001, China
| | - Shulan Chen
- Division of Microbiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Bin Cao
- Department of Respiratory and Crtical Care Medicine, Clinical Microbiology and Infectious Disease Laboratory, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital of Capital Medical University, Beijing, 100020, China
| | - Qiong Duan
- Microbiology Laboratory, Jilin Province People's Hospital, Changchun, 130021, China
| | - Shufang Zhang
- Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China
| | - Haifeng Shao
- Division of Microbiology, General Hospital of Nanjing Military Command, Nanjing, 210002, China
| | - Haishen Kong
- Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Bingdong Gui
- Clinical laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhidong Hu
- Division of Microbiology, Tianjin Medical University General Hospital, Tianjing, 300052, China
| | - Robert Badal
- Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA
| | - Yingchun Xu
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
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Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, Chang PK, O'Neill PJ, Mollen KP, Huston JM, Diaz JJ, Prince JM. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt) 2017; 18:1-76. [PMID: 28085573 DOI: 10.1089/sur.2016.261] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. METHODS Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. RESULTS This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. SUMMARY The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline.
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Affiliation(s)
- John E Mazuski
- 1 Department of Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | | | - Addison K May
- 3 Department of Surgery, Vanderbilt University , Nashville, Tennessee
| | - Robert G Sawyer
- 4 Department of Surgery, University of Virginia , Charlottesville, Virginia
| | - Evan P Nadler
- 5 Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Matthew R Rosengart
- 6 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Phillip K Chang
- 7 Department of Surgery, University of Kentucky , Lexington, Kentucky
| | | | - Kevin P Mollen
- 9 Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jared M Huston
- 10 Department of Surgery, Hofstra Northwell School of Medicine , Hempstead, New York
| | - Jose J Diaz
- 11 Department of Surgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Jose M Prince
- 12 Departments of Surgery and Pediatrics, Hofstra-Northwell School of Medicine , Hempstead, New York
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Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, Ceresoli M, Chiara O, Coccolini F, De Waele JJ, Di Saverio S, Eckmann C, Fraga GP, Giannella M, Girardis M, Griffiths EA, Kashuk J, Kirkpatrick AW, Khokha V, Kluger Y, Labricciosa FM, Leppaniemi A, Maier RV, May AK, Malangoni M, Martin-Loeches I, Mazuski J, Montravers P, Peitzman A, Pereira BM, Reis T, Sakakushev B, Sganga G, Soreide K, Sugrue M, Ulrych J, Vincent JL, Viale P, Moore EE. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg 2017; 12:22. [PMID: 28484510 PMCID: PMC5418731 DOI: 10.1186/s13017-017-0132-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/25/2017] [Indexed: 12/18/2022] Open
Abstract
This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.
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Affiliation(s)
| | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Walter L Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA
| | | | - Marco Ceresoli
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Osvaldo Chiara
- Emergency Department, Trauma Center, Niguarda Hospital, Milan, Italy
| | - Federico Coccolini
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Christian Eckmann
- Department of General, Visceral, and Thoracic Surgery, Klinikum Peine, Academic Hospital of Medical University Hannover, Hannover, Germany
| | - Gustavo P Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Ewen A Griffiths
- General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Jeffry Kashuk
- Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Andrew W Kirkpatrick
- Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, AB Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Francesco M Labricciosa
- Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Addison K May
- Departments of Surgery and Anesthesiology, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN USA
| | | | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Wellcome Trust-HRB Clinical Research, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland
| | - John Mazuski
- Department of Surgery, School of Medicine, Washington University in Saint Louis, St. Louis, MO USA
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France
| | - Andrew Peitzman
- Department of Surgery, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Bruno M Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Tarcisio Reis
- Emergency post-operative Department, Otavio De Freitas Hospital and Osvaldo Cruz Hospital Recife, Recife, Brazil
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Gabriele Sganga
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Michael Sugrue
- Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Jan Ulrych
- 1st Department of Surgery, Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Praha, Czech Republic
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Ernest E Moore
- Department of Surgery, University of Colorado, Denver, CO USA
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20
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Syue LS, Chen YH, Ko WC, Hsueh PR. New drugs for the treatment of complicated intra-abdominal infections in the era of increasing antimicrobial resistance. Int J Antimicrob Agents 2016; 47:250-8. [PMID: 27005457 DOI: 10.1016/j.ijantimicag.2015.12.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/23/2023]
Abstract
The continuing increase in multidrug-resistant organisms (MDROs) worldwide has created new challenges in treating complicated intra-abdominal infections (cIAIs). A number of novel antimicrobial agents have been developed against resistant pathogens. To target extended-spectrum β-lactamase (ESBL)-producing pathogens, novel β-lactam antibiotics, such as ceftolozane/tazobactam, ceftazidime/avibactam, aztreonam/avibactam, imipenem/relebactam and S-649266, are antimicrobial alternatives for cIAIs. Two new drugs, eravacycline and plazomicin, have activity against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae, carbapenem-resistant Acinetobacter baumannii and ESBL-producers. New lipoglycopeptides and oxazolidinones provide feasible options against resistant Gram-positive pathogens. These novel antimicrobials may play a role in improving the clinical outcomes of cIAIs caused by MDROs.
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Affiliation(s)
- Ling-Shan Syue
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
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21
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Maseda E, Gimenez MJ, Gilsanz F, Aguilar L. Basis for selecting optimum antibiotic regimens for secondary peritonitis. Expert Rev Anti Infect Ther 2015; 14:109-24. [PMID: 26568097 DOI: 10.1586/14787210.2016.1120669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Adequate management of severely ill patients with secondary peritonitis requires supportive therapy of organ dysfunction, source control of infection and antimicrobial therapy. Since secondary peritonitis is polymicrobial, appropriate empiric therapy requires combination therapy in order to achieve the needed coverage for both common and more unusual organisms. This article reviews etiological agents, resistance mechanisms and their prevalence, how and when to cover them and guidelines for treatment in the literature. Local surveillances are the basis for the selection of compounds in antibiotic regimens, which should be further adapted to the increasing number of patients with risk factors for resistance (clinical setting, comorbidities, previous antibiotic treatments, previous colonization, severity…). Inadequate antimicrobial regimens are strongly associated with unfavorable outcomes. Awareness of resistance epidemiology and of clinical consequences of inadequate therapy against resistant bacteria is crucial for clinicians treating secondary peritonitis, with delicate balance between optimization of empirical therapy (improving outcomes) and antimicrobial overuse (increasing resistance emergence).
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Affiliation(s)
- Emilio Maseda
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
| | | | - Fernando Gilsanz
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
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