Consequences of inappropriate initial empiric parenteral antibiotic therapy among patients with community-acquired intra-abdominal infections in Spain.
ABSTRACT To assess the association between inappropriate antibiotic therapy and clinical outcomes for complicated community-acquired intra-abdominal infections in Spain, patient records from October 1998 to August 2002 in 24 hospitals were reviewed. Initial empiric therapy was classified appropriate if all isolates were sensitive to at least 1 of the antibiotics administered. Multivariate analyses were performed to assess associations between appropriateness of therapy and patient outcomes. Healthcare resource use was measured as hospital length of stay (LOS) and d on intravenous antibiotic therapy. A total of 425 patients were included. Of these, 387 (91%) received appropriate initial empiric therapy. Patients on inappropriate therapy were less likely to have clinical success (79% vs 26%, p<0.001), more likely to require additional antibiotic therapy (40% vs 7%, p<0.01) and more likely to be re-hospitalized within 30 d of discharge (18% vs 3%, p<0.01). Multivariate analyses also showed that inappropriate therapy was associated with an almost 16% increase in LOS (p<0.05) and 26% in d of intravenous antibiotic therapy compared with appropriate therapy (p<0.05). Inappropriate initial antibiotic therapy was associated with a significantly higher proportion of unsuccessful patient outcomes (including death, re-operation, re-hospitalization or additional parental antibiotic therapies), increased length of stay and length on therapy.
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ABSTRACT: The development of antimicrobial resistant pathogens in surgical patients is a significant problem, and infections caused by these organisms are associated with increased morbidity and mortality. Programs to prevent the spread of resistant organisms emphasize standard infection control practices and appropriate antibiotic prescribing practices. Antibiotic restriction and selective reporting of bacterial susceptibilities have had limited success in decreasing development of resistance, and are difficult to maintain effectively in the absence of widespread clinician acceptance. Potentially more promising are integrated decision support tools, which can support optimal antibiotic selection while preserving the sense of clinician autonomy. The use of antibiotic cycling programs for critically ill patients may be another approach to preserving the efficacy of the currently antimicrobial against the continued pressure of increasing bacterial resistance.Surgical Clinics of North America 05/2009; 89(2):501-19, x. · 2.14 Impact Factor