An Evaluation of Treatment Patterns and Associated Outcomes Among Adult Hospitalized Patients With Lower-Risk Community-Acquired Complicated Intra-abdominal Infections: How Often Are Expert Guidelines Followed?
Open Access
- 1 July 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Open Forum Infectious Diseases
- Vol. 7 (7), ofaa237
- https://doi.org/10.1093/ofid/ofaa237
Abstract
Background. Expert guidelines discourage use of antipseudomonal B-lactams and fluoroquinolones in lower-risk patients with community-acquired complicated intra-abdominal infection (CA cIAI). Compliance with these recommendations across US hospitals is unclear. This study sought to determine treatment patterns and associated outcomes among adult hospitalized lower-risk patients with CA cIAI. Methods. A study using data from the Premier I Iealthcare Database (10/2015-12/2017) was performed. Inclusion criteria: age >= 18 years; hospitalized; had a cIAI at admission; and received antibiotics within the first 4 hospital days. Patients were excluded if they were high risk, were transferred from another health care facility, had a recent hospital admission, or received dialysis within 30 days of admission. Empiric antibiotic treatment patterns and associated outcomes were quantified. Results. Overall, 46 722 (66%) patients with cIAIs met the lower-risk CA IAI study criteria. Among lower-risk CA IAI patients, the mean (SD) age was 53.4 (18.2) years, and 71% had a Charlson Comorbidity Index score of 0. The most common diagnosis was acute appendicitis with peritonitis (59.7%). Among lower-risk CA IAI patients, 54% received piperacillin/tazobactam, 20% received a fluoroquinolone (FQ), 11% received ceftriaxone, and 7% received ampicillin/sulbactam. Overall, the median hospital length of stay was 4 days and median costs were $12 345 USD. Nearly 90% of patients were discharged home, and <1% died. Outcomes were similar across all empiric treatments received. Conclusions. Overuse of antipseudomonal beta-lactams and fluoroquinolones was commonplace among lower-risk CA IAI patients. These findings can serve as the basis for an antimicrobial stewardship initiative in hospitals aspiring to reduce the use of broad-spectrum antibiotics.Funding Information
- Tetraphase Pharmaceuticals
This publication has 27 references indexed in Scilit:
- Current concept of abdominal sepsis: WSES position paperWorld Journal of Emergency Surgery, 2014
- Epidemiology and antimicrobial susceptibility of Gram-negative aerobic bacteria causing intra-abdominal infections during 2010–2011Journal of Chemotherapy, 2014
- Medication risk factors associated with healthcare-associated Clostridium difficile infection: a multilevel model case-control study among 64 US academic medical centresJournal of Antimicrobial Chemotherapy, 2013
- Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired PneumoniaJAMA Internal Medicine, 2012
- Clinical epidemiology of carbapenem-intermediate or -resistant EnterobacteriaceaeJournal of Antimicrobial Chemotherapy, 2011
- Peritoneal fluid culture in appendicitis: Review in changing timesInternational Journal of Surgery, 2010
- Skin and Soft‐Tissue Infections Requiring Hospitalization at an Academic Medical Center: Opportunities for Antimicrobial StewardshipClinical Infectious Diseases, 2010
- Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2010
- Identification of Patients WithPseudomonas aeruginosaRespiratory Tract Infections at Greatest Risk of Infection With Carbapenem-Resistant IsolatesInfection Control & Hospital Epidemiology, 2007
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987