Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection

Inui, Tazo; Haridas, Manjunath; Claridge, Jeffrey A.; Malangoni, Mark A.

doi:10.1016/j.surg.2009.06.051

Cited by 54 publications

(45 citation statements)

References 24 publications

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“…4,10,11 One reason that shortening therapy has been difficult is the 20% rate of clinically significant infectious complications after treatment. 3 These subsequent complications, however, are often due to progression of the original disease or inadequate original source control and may not be preventable with antimicrobial therapy alone.…”

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Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

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BACKGROUND The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P = 0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

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Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

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“…[256] study, 452 patients, 234 (51.8%) had CIAIs and 218 (48.2%) had NIAIs, treated at a single urban academic hospital over 8 years (June 1999-June 2007) were retrospectively reviewed.…”

Section: Hospital-acquired Intra-abdominal Infectionsmentioning

confidence: 99%

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

et al. 2011

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Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

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“…There have been numerous studies published evaluating predictors of mortality in patients with IAI [6][7][8][9][10][11]. However, studies investigating predictors of mortality in patients with BSI of intra-abdominal origin are sparse.…”

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Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

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Skrupky

Symons

et al. 2015

Surgical Infections

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"Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia." Surgical Infections. 16,6. 785-793. (2015 Background: Patients with intra-abdominal sepsis and associated bacteremia have a high mortality rate. However, outcomes studies in this population are limited, in part because of the small numbers of such patients. The objective of this study was to describe characteristics of critically ill patients with secondary blood stream infection (BSI) of intra-abdominal origin and identify predictors of mortality.Methods: This retrospective, single-center study evaluated patients admitted between January 2005 and January 2011 with bacteremia because of an intra-abdominal source. Patients were included if they met criteria for severe sepsis based on International Classification of Diseases, 9th Revision (ICD 9) codes for acute organ dysfunction, had a positive blood culture, had at least one ICD 9 code indicative of an intra-abdominal process, and had a confirmed or clinically suspected intra-abdominal infection (IAI) within 72 h of the blood culture. Chart review was performed to confirm the presence of these criteria and also the absence of any other potential source of bacteremia. Data were collected on patient demographics, BSI source, source control procedure details, microorganisms isolated, and antibiotics administered. Multivariable logistic regression analysis was performed to identify independent predictors of mortality. Results: Three hundred six patients with BSI were identified, of which 108 episodes were deemed to be of intraabdominal origin. Gram-negative organisms comprised 43% of blood isolates, followed by gram-positives (33%), anaerobes (14%), and yeast (9%). Appropriate antimicrobial therapy was administered in 71% of patients. The overall mortality rate was 27.8%. As compared with survivors, non-survivors were older, more likely to have underlying COPD or asthma, and have renal or metabolic failure (p < 0.05 for all). Among non-survivors, adequate source control was obtained less frequently (64% vs. 91%, p = 0.002) and median time to appropriate antibiotics was longer (23 h vs. 4 h, p = 0.004). Logistic regression analysis revealed inadequate source control (p = 0.002) and inappropriate antibiotics (p = 0.016) to be independently associated with mortality. Conclusions: Critically ill patients with a BSI of abdominal origin are at high risk for mortality. Failure to achieve adequate source control and administration of inappropriate antibiotics were independent predictors of mortality. Thus, these represent potential opportunities to impact outcomes in patients with complicated IAI.

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Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection

Cited by 54 publications

References 24 publications

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia

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