Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections: A Post Hoc Analysis

James M. Sanders, Jeffrey M. Tessier, Robert G. Sawyer, Pam A. Lipsett, Preston R. Miller, Nicholas Namias, Patrick J. O'Neill, E. P. Dellinger, Raul Coimbra, Chris A. Guidry, Joseph Cuschieri, Kaysie L. Banton, Charles H. Cook, Billy J. Moore, Therese M. Duane

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Management of complicated intra-abdominal infections (cIAIs) includes broad-spectrum antimicrobial coverage and commonly includes vancomycin for the empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Ideally, culture-guided de-escalation follows to promote robust antimicrobial stewardship. This study assessed the impact and necessity of vancomycin in cIAI treatment regimens. Patients and Methods: A post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was performed. Patients receiving piperacillin-tazobactam (P/T) and/or a carbapenem were included with categorization based on use of vancomycin. Univariate and multivariable analyses evaluated effects of including vancomycin on individual and the composite of undesirable outcomes (recurrent IAI, surgical site infection [SSI], or death). Results: The study cohort included 344 patients with 110 (32%) patients receiving vancomycin. Isolation of MRSA occurred in only eight (2.3%) patients. Vancomycin use was associated with a similar composite outcome, 29.1%, vs. no vancomycin, 22.2% (p = 0.17). Patients receiving vancomycin had (mean [standard deviation]) higher Acute Physiology and Chronic Health Evaluation II scores (13.1 [6.6] vs. 9.4 [5.7], p < 0.0001), extended length of stay (12.6 [10.2] vs. 8.6 [8.0] d, p < 0.001), and prolonged antibiotic courses (9.1 [8.0] vs. 7.1 [4.9] d, p = 0.02). After risk adjustment in a multivariate model, no significant difference existed for the measured outcomes. Conclusions: This post hoc analysis reveals that addition of vancomycin occurred in nearly one third of patients and more often in sicker patients. Despite this selection bias, no appreciable differences in undesired outcomes were demonstrated, suggesting limited utility for adding vancomycin to cIAI treatment regimens.

Original languageEnglish (US)
Pages (from-to)694-699
Number of pages6
JournalSurgical Infections
Volume17
Issue number6
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Intraabdominal Infections
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Risk Adjustment
Surgical Wound Infection
Carbapenems
APACHE
Selection Bias
Length of Stay
Cohort Studies
Therapeutics
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections : A Post Hoc Analysis. / Sanders, James M.; Tessier, Jeffrey M.; Sawyer, Robert G.; Lipsett, Pam A.; Miller, Preston R.; Namias, Nicholas; O'Neill, Patrick J.; Dellinger, E. P.; Coimbra, Raul; Guidry, Chris A.; Cuschieri, Joseph; Banton, Kaysie L.; Cook, Charles H.; Moore, Billy J.; Duane, Therese M.

In: Surgical Infections, Vol. 17, No. 6, 01.12.2016, p. 694-699.

Research output: Contribution to journalArticle

Sanders, JM, Tessier, JM, Sawyer, RG, Lipsett, PA, Miller, PR, Namias, N, O'Neill, PJ, Dellinger, EP, Coimbra, R, Guidry, CA, Cuschieri, J, Banton, KL, Cook, CH, Moore, BJ & Duane, TM 2016, 'Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections: A Post Hoc Analysis', Surgical Infections, vol. 17, no. 6, pp. 694-699. https://doi.org/10.1089/sur.2016.095
Sanders, James M. ; Tessier, Jeffrey M. ; Sawyer, Robert G. ; Lipsett, Pam A. ; Miller, Preston R. ; Namias, Nicholas ; O'Neill, Patrick J. ; Dellinger, E. P. ; Coimbra, Raul ; Guidry, Chris A. ; Cuschieri, Joseph ; Banton, Kaysie L. ; Cook, Charles H. ; Moore, Billy J. ; Duane, Therese M. / Inclusion of Vancomycin as Part of Broad-Spectrum Coverage Does Not Improve Outcomes in Patients with Intra-Abdominal Infections : A Post Hoc Analysis. In: Surgical Infections. 2016 ; Vol. 17, No. 6. pp. 694-699.
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abstract = "Background: Management of complicated intra-abdominal infections (cIAIs) includes broad-spectrum antimicrobial coverage and commonly includes vancomycin for the empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Ideally, culture-guided de-escalation follows to promote robust antimicrobial stewardship. This study assessed the impact and necessity of vancomycin in cIAI treatment regimens. Patients and Methods: A post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was performed. Patients receiving piperacillin-tazobactam (P/T) and/or a carbapenem were included with categorization based on use of vancomycin. Univariate and multivariable analyses evaluated effects of including vancomycin on individual and the composite of undesirable outcomes (recurrent IAI, surgical site infection [SSI], or death). Results: The study cohort included 344 patients with 110 (32{\%}) patients receiving vancomycin. Isolation of MRSA occurred in only eight (2.3{\%}) patients. Vancomycin use was associated with a similar composite outcome, 29.1{\%}, vs. no vancomycin, 22.2{\%} (p = 0.17). Patients receiving vancomycin had (mean [standard deviation]) higher Acute Physiology and Chronic Health Evaluation II scores (13.1 [6.6] vs. 9.4 [5.7], p < 0.0001), extended length of stay (12.6 [10.2] vs. 8.6 [8.0] d, p < 0.001), and prolonged antibiotic courses (9.1 [8.0] vs. 7.1 [4.9] d, p = 0.02). After risk adjustment in a multivariate model, no significant difference existed for the measured outcomes. Conclusions: This post hoc analysis reveals that addition of vancomycin occurred in nearly one third of patients and more often in sicker patients. Despite this selection bias, no appreciable differences in undesired outcomes were demonstrated, suggesting limited utility for adding vancomycin to cIAI treatment regimens.",
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T2 - A Post Hoc Analysis

AU - Sanders, James M.

AU - Tessier, Jeffrey M.

AU - Sawyer, Robert G.

AU - Lipsett, Pam A.

AU - Miller, Preston R.

AU - Namias, Nicholas

AU - O'Neill, Patrick J.

AU - Dellinger, E. P.

AU - Coimbra, Raul

AU - Guidry, Chris A.

AU - Cuschieri, Joseph

AU - Banton, Kaysie L.

AU - Cook, Charles H.

AU - Moore, Billy J.

AU - Duane, Therese M.

PY - 2016/12/1

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N2 - Background: Management of complicated intra-abdominal infections (cIAIs) includes broad-spectrum antimicrobial coverage and commonly includes vancomycin for the empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Ideally, culture-guided de-escalation follows to promote robust antimicrobial stewardship. This study assessed the impact and necessity of vancomycin in cIAI treatment regimens. Patients and Methods: A post hoc analysis of the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial was performed. Patients receiving piperacillin-tazobactam (P/T) and/or a carbapenem were included with categorization based on use of vancomycin. Univariate and multivariable analyses evaluated effects of including vancomycin on individual and the composite of undesirable outcomes (recurrent IAI, surgical site infection [SSI], or death). Results: The study cohort included 344 patients with 110 (32%) patients receiving vancomycin. Isolation of MRSA occurred in only eight (2.3%) patients. Vancomycin use was associated with a similar composite outcome, 29.1%, vs. no vancomycin, 22.2% (p = 0.17). Patients receiving vancomycin had (mean [standard deviation]) higher Acute Physiology and Chronic Health Evaluation II scores (13.1 [6.6] vs. 9.4 [5.7], p < 0.0001), extended length of stay (12.6 [10.2] vs. 8.6 [8.0] d, p < 0.001), and prolonged antibiotic courses (9.1 [8.0] vs. 7.1 [4.9] d, p = 0.02). After risk adjustment in a multivariate model, no significant difference existed for the measured outcomes. Conclusions: This post hoc analysis reveals that addition of vancomycin occurred in nearly one third of patients and more often in sicker patients. Despite this selection bias, no appreciable differences in undesired outcomes were demonstrated, suggesting limited utility for adding vancomycin to cIAI treatment regimens.

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