PMID- 24824591
OWN - NLM
STAT- MEDLINE
DCOM- 20150407
LR  - 20211021
IS  - 1557-8674 (Electronic)
IS  - 1096-2964 (Print)
IS  - 1096-2964 (Linking)
VI  - 15
IP  - 4
DP  - 2014 Aug
TI  - 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.
PG  - 417-24
LID - 10.1089/sur.2012.077 [doi]
AB  - 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, chi(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.
FAU - Riccio, Lin M
AU  - Riccio LM
AD  - Department of Surgery, University of Virginia Health System , Charlottesville, 
      Virginia.
FAU - Popovsky, Kimberley A
AU  - Popovsky KA
FAU - Hranjec, Tjasa
AU  - Hranjec T
FAU - Politano, Amani D
AU  - Politano AD
FAU - Rosenberger, Laura H
AU  - Rosenberger LH
FAU - Tura, Kristin C
AU  - Tura KC
FAU - Sawyer, Robert G
AU  - Sawyer RG
LA  - eng
GR  - T32 AI078875/AI/NIAID NIH HHS/United States
PT  - Journal Article
DEP - 20140513
PL  - United States
TA  - Surg Infect (Larchmt)
JT  - Surgical infections
JID - 9815642
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/*adverse effects/*therapeutic use
MH  - Bacterial Infections/*drug therapy/*mortality
MH  - Female
MH  - Humans
MH  - Intraabdominal Infections/*complications/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Survival Analysis
MH  - Time Factors
PMC - PMC4696422
EDAT- 2014/05/16 06:00
MHDA- 2015/04/08 06:00
PMCR- 2015/08/01
CRDT- 2014/05/15 06:00
PHST- 2014/05/15 06:00 [entrez]
PHST- 2014/05/16 06:00 [pubmed]
PHST- 2015/04/08 06:00 [medline]
PHST- 2015/08/01 00:00 [pmc-release]
AID - 10.1089/sur.2012.077 [pii]
AID - 10.1089/sur.2012.077 [doi]
PST - ppublish
SO  - Surg Infect (Larchmt). 2014 Aug;15(4):417-24. doi: 10.1089/sur.2012.077. Epub 
      2014 May 13.