Clinical and Therapeutic Features of Nonpostoperative Nosocomial Intra-abdominal Infections
- 1 March 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 239 (3), 409-416
- https://doi.org/10.1097/01.sla.0000114214.68169.e9
Abstract
To compare the clinical, microbiological, and therapeutic features of nonpostoperative nosocomial intra-abdominal infections (non-PostopNAI) with community-acquired intra-abdominal infections (CAI). Prospective (June 2000 through January 2001) consecutive case series analysis of patients operated for secondary nonpostoperative intra-abdominal infections collected in 176 study centers (surgical wards and intensive care units). Clinical, microbiological, and therapeutic characteristics of CAI and non-PostopNAI infections were collected. Management of antibiotic therapy was decided by the attending physician. The efficacy of treatment was evaluated over a 30-day period after the index episode. Evaluatable observations (n = 1008) were collected (761 CAI and 247 non-PostopNAI), including 285 intensive care unit patients. When compared with CAI patients, non-PostopNAI patients presented an increased interval between admission to the surgical ward and operation (1.3 +/- 1.5 vs. 0.5 +/- 0.7 days in CAI patients; P < 0.001), increased proportions of underlying diseases, a more severe clinical condition as assessed by increased proportions of hospitalization in the intensive care unit (48% vs. 22% in CAI patients, P < 0.001) and a higher SAPS II score (34 +/- 15 vs. 24 +/- 14, P < 0.001). In non-PostopNAI patients, increased proportions of therapeutic failure (15% vs. 7% in CAI patients, P < 0.01) and of fatalities (12% vs. 4% in CAI patients, P < 0.001) were observed. Delayed diagnosis and increased severity are the main characteristics of non-PostopNAI infections. Microbiological features are quite similar in CAI and non-PostopNAI infections, suggesting that antibiotic therapy recommended for CAI infections could be applied to non-PostopNAI patients. Characteristics of non-PostopNAI patients should lead to identify them as a specific entity in clinical trials.Keywords
This publication has 29 references indexed in Scilit:
- The Surgical Infection Society Guidelines on Antimicrobial Therapy for Intra-Abdominal Infections: Evidence for the RecommendationsSurgical Infections, 2002
- The Microbiology of Postoperative PeritonitisClinical Infectious Diseases, 2001
- Antimicrobial Susceptibility and Frequency of Occurrence of Clinical Blood Isolates in Europe from the SENTRY Antimicrobial Surveillance Program, 1997 and 1998Clinical Infectious Diseases, 2000
- Emergence of Antibiotic-Resistant Bacteria in Cases of Peritonitis After Intraabdominal Surgery Affects the Efficacy of Empirical Antimicrobial TherapyClinical Infectious Diseases, 1996
- A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter studyJAMA, 1993
- Clinical Relevance of Susceptibility Testing of Anaerobic BacteriaClinical Infectious Diseases, 1993
- Variation in the Susceptibility of Bacteroides fragilis Group Isolates from Six Chicago HospitalsClinical Infectious Diseases, 1993
- Antibiotic Treatment for Surgical PeritonitisAnnals of Surgery, 1991
- CLINICAL SIGNIFICANCE OF CANDIDA ISOLATED FROM PERITONEUM IN SURGICAL PATIENTSThe Lancet, 1989
- Role of aminoglycoside antibiotics in the treatment of intra-abdominal infectionAntimicrobial Agents and Chemotherapy, 1987