Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death: a study of 2,552 consecutive infections.

Abstract

BACKGROUND:

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, χ(2) 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±0.3 vs. 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.

• Authors: Lin M Riccio, Kimberley A Popovsky, Tjasa Hranjec, Amani D Politano, Laura H Rosenberger, Kristin C Tura, Robert G Sawyer
• Journal: Surgical infections (Surg Infect (Larchmt)) Vol. 15 Issue 4 Pg. 417-24 (Aug 2014) ISSN: 1557-8674 [Electronic] United States
• PMID: 24824591 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Bacterial Infections (drug therapy, mortality)
• Female
• Humans
• Intraabdominal Infections (complications, drug therapy)
• Male
• Middle Aged
• Prospective Studies
• Survival Analysis
• Time Factors