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Spectrum adequacy of antibiotic regimens for secondary peritonitis: a retrospective analysis in intermediate and intensive care unit patients.

Steinbach CL, Töpper C, Adam T, Kees MG - Ann. Clin. Microbiol. Antimicrob. (2015)

Bottom Line: The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin.When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised.As for Candida spp., the SAR of fluconazole was 81.9-87.5 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Charité Universitätsmedizin Berlin-Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. catherine.steinbach@charite.de.

ABSTRACT

Background: Secondary peritonitis requires surgical source control and adequate antimicrobial treatment. Antimicrobial regimens are usually selected according to local susceptibility data of individual pathogens against single agents, but this neglects both the polymicrobial nature of the infection and the use of combination therapy. We analysed the probability of common regimens to cover all relevant pathogens isolated in one patient ("spectrum adequacy rate", SAR) in a real-life data set.

Methods: Data from 242 patients with secondary peritonitis (88 community acquired, 154 postoperative cases) treated in our IMCU/ICU were obtained retrospectively. The relative frequency of pathogens, resistance rates and the SAR were analysed using the free software R.

Results: Enterococci were isolated in 47.1 % of all patients, followed by Escherichia coli (42.6 %), other enterobacteriaceae (33.1 %), anaerobes (29.8 %) and Candida spp. (28.9 %). Resistance patterns were consistent with general surveillance data from our hospital. The susceptibility rates and SAR were lower in postoperative than in community acquired cases. The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin. When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised. As for Candida spp., the SAR of fluconazole was 81.9-87.5 %.

Conclusions: This study demonstrates a rational approach to assess the adequacy of antimicrobial regimens in secondary peritonitis, which may help to adjust local guidelines or to select candidate regimens for clinical studies.

No MeSH data available.


Related in: MedlinePlus

Prevalence of selected groups of pathogens isolated in patients with secondary peritonitis, according to site of lesion
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Fig2: Prevalence of selected groups of pathogens isolated in patients with secondary peritonitis, according to site of lesion

Mentions: The relevant population was composed of 242 patients who had undergone surgery for confirmed secondary peritonitis, among which 88 had community acquired and 154 postoperative peritonitis. Case characteristics are displayed in Table 1. A total of 654 different strains was isolated, details are shown in Table 2. The number of isolated pathogens per patient was equal in community acquired and postoperative disease (median 2, interquartile range 1–4), the maximum number observed being eight. Figure 1 gives a graphical representation of the simultaneous isolation of relevant pathogens. Overall, Enterococcus spp. was the most prevalent category of pathogens, and was isolated in a high percentage of cases independently of the clinical setting or the anatomical site of intestinal lesion (Fig. 2). Escherichia coli was also isolated in about 40 % of the cases independently of the clinical setting, but was far less common in proximal than in distal intestinal lesions. The opposite was true for Candida spp., being cultured in about 70 % of gastroduodenal lesions, but in less than 20 % of those in the colon or rectum.Table 1


Spectrum adequacy of antibiotic regimens for secondary peritonitis: a retrospective analysis in intermediate and intensive care unit patients.

Steinbach CL, Töpper C, Adam T, Kees MG - Ann. Clin. Microbiol. Antimicrob. (2015)

Prevalence of selected groups of pathogens isolated in patients with secondary peritonitis, according to site of lesion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4635547&req=5

Fig2: Prevalence of selected groups of pathogens isolated in patients with secondary peritonitis, according to site of lesion
Mentions: The relevant population was composed of 242 patients who had undergone surgery for confirmed secondary peritonitis, among which 88 had community acquired and 154 postoperative peritonitis. Case characteristics are displayed in Table 1. A total of 654 different strains was isolated, details are shown in Table 2. The number of isolated pathogens per patient was equal in community acquired and postoperative disease (median 2, interquartile range 1–4), the maximum number observed being eight. Figure 1 gives a graphical representation of the simultaneous isolation of relevant pathogens. Overall, Enterococcus spp. was the most prevalent category of pathogens, and was isolated in a high percentage of cases independently of the clinical setting or the anatomical site of intestinal lesion (Fig. 2). Escherichia coli was also isolated in about 40 % of the cases independently of the clinical setting, but was far less common in proximal than in distal intestinal lesions. The opposite was true for Candida spp., being cultured in about 70 % of gastroduodenal lesions, but in less than 20 % of those in the colon or rectum.Table 1

Bottom Line: The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin.When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised.As for Candida spp., the SAR of fluconazole was 81.9-87.5 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Charité Universitätsmedizin Berlin-Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. catherine.steinbach@charite.de.

ABSTRACT

Background: Secondary peritonitis requires surgical source control and adequate antimicrobial treatment. Antimicrobial regimens are usually selected according to local susceptibility data of individual pathogens against single agents, but this neglects both the polymicrobial nature of the infection and the use of combination therapy. We analysed the probability of common regimens to cover all relevant pathogens isolated in one patient ("spectrum adequacy rate", SAR) in a real-life data set.

Methods: Data from 242 patients with secondary peritonitis (88 community acquired, 154 postoperative cases) treated in our IMCU/ICU were obtained retrospectively. The relative frequency of pathogens, resistance rates and the SAR were analysed using the free software R.

Results: Enterococci were isolated in 47.1 % of all patients, followed by Escherichia coli (42.6 %), other enterobacteriaceae (33.1 %), anaerobes (29.8 %) and Candida spp. (28.9 %). Resistance patterns were consistent with general surveillance data from our hospital. The susceptibility rates and SAR were lower in postoperative than in community acquired cases. The following regimens yielded a SAR > 95 % when enterobacteriaceae only were considered: piperacillin/tazobactam + gentamicin, cefotaxim (only for community acquired cases), cefotaxim + gentamicin, meropenem, tigecycline + gentamicin or tigecycline + ciprofloxaxin. When enterococci were also considered, all betalactam based regimens required combination with vancomycin or linezolid for a SAR > 95 %, whereas TGC based regimens were not compromised. As for Candida spp., the SAR of fluconazole was 81.9-87.5 %.

Conclusions: This study demonstrates a rational approach to assess the adequacy of antimicrobial regimens in secondary peritonitis, which may help to adjust local guidelines or to select candidate regimens for clinical studies.

No MeSH data available.


Related in: MedlinePlus