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Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis.

Augustin P, Kermarrec N, Muller-Serieys C, Lasocki S, Chosidow D, Marmuse JP, Valin N, Desmonts JM, Montravers P - Crit Care (2010)

Bottom Line: Imipenem/cilastin was the only single-drug regimen providing an adequacy superior to 80% in the absence of broad spectrum antibiotic between initial surgery and reoperation.Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR.For other patients, only antibiotic combinations may achieve high adequacy rates.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Surgical Intensive Care Unit, Hôpital Bichat-Claude Bernard, Université Paris VII Denis Diderot, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. pascalaugustin@hotmail.com

ABSTRACT

Introduction: The main objective was to determine risk factors for presence of multidrug resistant bacteria (MDR) in postoperative peritonitis (PP) and optimal empirical antibiotic therapy (EA) among options proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines.

Methods: One hundred patients hospitalised in the intensive care unit (ICU) for PP were reviewed. Clinical and microbiologic data, EA and its adequacy were analysed. The in vitro activities of 9 antibiotics in relation to the cultured bacteria were assessed to propose the most adequate EA among 17 regimens in the largest number of cases.

Results: A total of 269 bacteria was cultured in 100 patients including 41 episodes with MDR. According to logistic regression analysis, the use of broad-spectrum antibiotic between initial intervention and reoperation was the only significant risk factor for emergence of MDR bacteria (odds ratio (OR) = 5.1; 95% confidence interval (CI) = 1.7 - 15; P = 0.0031). Antibiotics providing the best activity rate were imipenem/cilastatin (68%) and piperacillin/tazobactam (53%). The best adequacy for EA was obtained by combinations of imipenem/cilastatin or piperacillin/tazobactam, amikacin and a glycopeptide, with values reaching 99% and 94%, respectively. Imipenem/cilastin was the only single-drug regimen providing an adequacy superior to 80% in the absence of broad spectrum antibiotic between initial surgery and reoperation.

Conclusions: Interval antibiotic therapy is associated with the presence of MDR bacteria. Not all regimens proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines for PP can provide an acceptable rate of adequacy. Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR. For other patients, only antibiotic combinations may achieve high adequacy rates.

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Adequacy rates of 17 theoretical antibiotic regimens according to the presence or absence of broad-spectrum IA. cip, ciprofloxacin; met, metronidazole; IA, interval antibiotics; pip/taz, piperacillin/tazobactam.
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Figure 2: Adequacy rates of 17 theoretical antibiotic regimens according to the presence or absence of broad-spectrum IA. cip, ciprofloxacin; met, metronidazole; IA, interval antibiotics; pip/taz, piperacillin/tazobactam.

Mentions: Evaluation of the adequacy rates of 17 theoretical regimens in the 100 episodes of PP according to the presence or absence of MDR bacteria, and according to the prescription of a broad-spectrum IA are shown in Figures 1 and 2, respectively. Only combination regimens including vancomycin achieved empirical therapy adequacy rates higher than 80%. Regimens based on imipenem/cilastatin obtained the highest adequacy rate. In patients with broad-spectrum IA, monotherapy with imipenem/cilastatin provided only poor adequacy rates, but was suitable for patients without broad-spectrum IA. Monotherapy with pip/taz gave poor results even in patients without broad-spectrum IA.


Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis.

Augustin P, Kermarrec N, Muller-Serieys C, Lasocki S, Chosidow D, Marmuse JP, Valin N, Desmonts JM, Montravers P - Crit Care (2010)

Adequacy rates of 17 theoretical antibiotic regimens according to the presence or absence of broad-spectrum IA. cip, ciprofloxacin; met, metronidazole; IA, interval antibiotics; pip/taz, piperacillin/tazobactam.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875535&req=5

Figure 2: Adequacy rates of 17 theoretical antibiotic regimens according to the presence or absence of broad-spectrum IA. cip, ciprofloxacin; met, metronidazole; IA, interval antibiotics; pip/taz, piperacillin/tazobactam.
Mentions: Evaluation of the adequacy rates of 17 theoretical regimens in the 100 episodes of PP according to the presence or absence of MDR bacteria, and according to the prescription of a broad-spectrum IA are shown in Figures 1 and 2, respectively. Only combination regimens including vancomycin achieved empirical therapy adequacy rates higher than 80%. Regimens based on imipenem/cilastatin obtained the highest adequacy rate. In patients with broad-spectrum IA, monotherapy with imipenem/cilastatin provided only poor adequacy rates, but was suitable for patients without broad-spectrum IA. Monotherapy with pip/taz gave poor results even in patients without broad-spectrum IA.

Bottom Line: Imipenem/cilastin was the only single-drug regimen providing an adequacy superior to 80% in the absence of broad spectrum antibiotic between initial surgery and reoperation.Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR.For other patients, only antibiotic combinations may achieve high adequacy rates.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Surgical Intensive Care Unit, Hôpital Bichat-Claude Bernard, Université Paris VII Denis Diderot, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. pascalaugustin@hotmail.com

ABSTRACT

Introduction: The main objective was to determine risk factors for presence of multidrug resistant bacteria (MDR) in postoperative peritonitis (PP) and optimal empirical antibiotic therapy (EA) among options proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines.

Methods: One hundred patients hospitalised in the intensive care unit (ICU) for PP were reviewed. Clinical and microbiologic data, EA and its adequacy were analysed. The in vitro activities of 9 antibiotics in relation to the cultured bacteria were assessed to propose the most adequate EA among 17 regimens in the largest number of cases.

Results: A total of 269 bacteria was cultured in 100 patients including 41 episodes with MDR. According to logistic regression analysis, the use of broad-spectrum antibiotic between initial intervention and reoperation was the only significant risk factor for emergence of MDR bacteria (odds ratio (OR) = 5.1; 95% confidence interval (CI) = 1.7 - 15; P = 0.0031). Antibiotics providing the best activity rate were imipenem/cilastatin (68%) and piperacillin/tazobactam (53%). The best adequacy for EA was obtained by combinations of imipenem/cilastatin or piperacillin/tazobactam, amikacin and a glycopeptide, with values reaching 99% and 94%, respectively. Imipenem/cilastin was the only single-drug regimen providing an adequacy superior to 80% in the absence of broad spectrum antibiotic between initial surgery and reoperation.

Conclusions: Interval antibiotic therapy is associated with the presence of MDR bacteria. Not all regimens proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines for PP can provide an acceptable rate of adequacy. Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR. For other patients, only antibiotic combinations may achieve high adequacy rates.

Show MeSH
Related in: MedlinePlus