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Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections

Published online by Cambridge University Press:  28 March 2006

Marisa Baré ,
Xavier Castells ,
Angel Garcia ,
Marta Riu ,
Mercè Comas  and
Maria José Gil Egea
Marisa Baré
Affiliation:
UDIAT-CD, Corporació Sanitària Parc Taulí
Xavier Castells
Affiliation:
Universitat Autònoma de Barcelona and Institut Municipal d'Assistència Sanitària
Angel Garcia
Affiliation:
Corporació Sanitària Parc Taulí
Marta Riu
Affiliation:
Institut Municipal d'Assistència Sanitària
Mercè Comas
Affiliation:
Institut Municipal d'Assistència Sanitària
Maria José Gil Egea
Affiliation:
Institut Municipal d'Assistència Sanitària
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Abstract

Objectives: The objective of this study is to describe the frequency of inappropriate empirical antibiotic therapy in secondary intra-abdominal infection and to identify the possible relationship between inappropriateness and some clinical outcomes.

Methods: A retrospective descriptive multicenter study was conducted using hospital secondary databases developed at two university hospitals located in northeast Spain. Participants were patients 18 years of age or older who were diagnosed with community-acquired intra-abdominal infections between January 1, 1998, and December 31, 2000, identified through computerized patient records using ICD-9 codes. Appropriateness of empirical treatment was defined according to the recommendations of the literature. The clinical outcome of each patient was classified as one of the following: (i) resolved with initial therapy, (ii) required second-line antibiotics, (iii) required re-operation, or (iv) in-hospital death. The Fisher's exact test or the Chi-squared test for categorical variables and the t-test or Mann–Whitney test for continuous variables were used for comparing groups. Conditional logistic and linear regression analyses were also applied.

Results: Of 376 cases, 51 cases (13.6 percent, 95 percent confidence interval, 10–17 percent) received inappropriate empirical antibiotic therapy according to the scientific literature. Inappropriate initial empirical treatment was significantly associated with the need for a second line of antibiotics (p<.001), although not with re-operation, mortality, or length of hospitalization.

Conclusions: Approximately 14 percent of the patients received inappropriate empirical antibiotic treatment. Worse clinical outcomes consistently were observed in the group of patients receiving inappropriate empirical treatment. The appropriateness of antibiotic treatment for a given infection, in light of the availability of clearly defined clinical guidelines is an easily evaluated aspect of the quality of care.

Keywords

AppropriatenessOutcomes assessmentEmpirical therapyMortalityIntra-abdominal infectionQuality of care
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 2 , April 2006 , pp. 242 - 248
Copyright
© 2006 Cambridge University Press

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References

Baré M, Jordana R, Toribio R, et al. 2004 In-patient treatment decisions [in Spanish]. Med Clin (Barc). 122: 130– 133.Google Scholar
Battleman DS, Callahan M, Thaler HT. 2002 Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia. Link between quality of care and resource utilization. Arch Intern Med. 162: 682– 688.Google Scholar
Charlson ME, Pompei P, Ales K, Mackenzie CR. 1987 A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chron Dis. 40: 373– 383.Google Scholar
Cheadle WG, Spain DA. 2003 The continuing challenge of intra-abdominal infection. Am J Surg. 186: 15S– 22S.Google Scholar
Christou NV, Turgeon P, Wassef R, et al. 1996 Management of intra-abdominal infections. The case for intraoperative cultures and comprehensive broad-spectrum antibiotic coverage. Arch Surg. 131: 1193– 1201.Google Scholar
Daley J, Henderson WG, Khuri SF. 2001 Risk-adjusted surgical outcomes. Annu Rev Med. 52: 275– 287.Google Scholar
Desharnais S, McMahon L, Wroblewski R, Hogan A. 1990 Measuring hospital performance. The development and validation of risk-adjusted indexes of mortality, readmissions and complications. Med Care. 28: 1127– 1141.Google Scholar
Dranitsaris G, Spizzirri D, Pitre M, McGeer A. 2001 A randomized trial to measure the optimal role of the pharmacist in promoting evidence-based antibiotic use in acute care hospials. Int J Technol Assess Health Care. 17: 171– 180.Google Scholar
Garau X, Gurguí M, Moreno A, Sitges-Serra A, Blanes M. Protocolos clínicos SEIM. IX. Peritonitis y otras infecciones intraabdominales. Aguado JM, Almirante B, Fortún J, eds. Available at: http//www.seimc.org/protocolos/clinicos/index.htm.
Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, et al. 2003 Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med. 31: 2742– 2751.Google Scholar
Grunau G, Heemken R, Hau T. 1996 Predictors of outcome in patients with postoperative intra-abdominal infection. Eur J Surg. 162: 619– 625.Google Scholar
Kollef MH, Sherman G, Ward S, Fraser V. 1999 Inadequate antimicrobial treatment of infections. A risk factor for hospital mortality among critically ill patients. Chest. 115: 462– 474.Google Scholar
Krobot K, Yin D, Zhang Q, et al. 2004 Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis. 23: 682– 687.Google Scholar
Mazuski JE. 2002; The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: Evidence for the recommendations. Surg Infect (Larchmt). 3: 175– 233.Google Scholar
McClean KL, Sheehan GJ, Harding GKM. 1994 Intraabdominal infection: A review. Clin Infect Dis. 19: 100– 116.Google Scholar
Mosdell DM, Morris DM, Voltura A, et al. 1991 Antibiotic treatment for surgical peritonitis. Ann Surg. 214: 543– 549.Google Scholar
Nichols RL. 1996; Intraabdominal infections—a surgical perspective. Clinical updates in infectious diseases. 3 (1). Available at: http://www.nfid.org/publications/clinicalupdates/id/intraabdominal.html.Google Scholar
Richardson JD, Cocanour CS, Kern JA, et al. 2004 Perioperative risk assessment in elderly and high-risk patients. J Am Coll Surg. 199: 133– 146.Google Scholar
Solomkin JS, Mazuski JE, Baron EJ, et al. 2003 Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis. 37: 997– 1005.Google Scholar