TY - JOUR
T1 - Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death
T2 - A study of 2,552 consecutive infections
AU - Riccio, Lin M.
AU - Popovsky, Kimberley A.
AU - Hranjec, Tjasa
AU - Politano, Amani D.
AU - Rosenberger, Laura H.
AU - Tura, Kristin C.
AU - Sawyer, Robert G.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. Methods: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ2 analysis, Wilcoxon rank sum test, and multi-variable analysis. Results: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). Conclusions: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.
AB - We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. Methods: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ2 analysis, Wilcoxon rank sum test, and multi-variable analysis. Results: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). Conclusions: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.
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U2 - 10.1089/sur.2012.077
DO - 10.1089/sur.2012.077
M3 - Article
C2 - 24824591
AN - SCOPUS:84906265299
SN - 1096-2964
VL - 15
SP - 417
EP - 424
JO - Surgical Infections
JF - Surgical Infections
IS - 4
ER -