Chong Yong Pil, Bae In-Gyu, Lee Sang-Rok, Chung Jin-Won, Jun Jae-Bum, Choo Eun Ju, Moon Soo-youn, Lee Mi Suk, Jeon Min Hyok, Song Eun Hee, Lee Eun Jung, Park Seong Yeon, Kim Yang Soo
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
PLoS One. 2015 Apr 24;10(4):e0119956. doi: 10.1371/journal.pone.0119956. eCollection 2015.
Complicated intra-abdominal infection (cIAI) is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.
A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.
A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14%) had health care-associated infection, and 48 (9%) experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.
To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.
复杂性腹腔内感染（cIAI）是指感染超出起始的中空脏器并蔓延至腹膜腔，且伴有脓肿形成或腹膜炎。很少有研究评估cIAI初始抗生素治疗失败所带来的实际成本和后果。本研究的目的是评估社区获得性cIAI初始抗生素治疗失败的危险因素及其对成本和后果的影响。
在11家三级医疗机构进行了一项回顾性研究。纳入2008年８月至2011年9月期间因社区获得性cIAI住院并接受了适当源头控制措施的成年患者。初始抗生素治疗失败定义为在第一周内，由于与cIAI相关的临床症状和体征未改善而更换抗生素。
共有514例因社区获得性cIAI住院的患者纳入分析。患者的平均年龄为53.3±17.6岁，72例（14%）有医疗保健相关感染，48例（9%）经历了初始抗生素治疗失败。初始抗生素治疗失败与成本增加和发病率升高相关。在对协变量进行调整后，初始治疗未成功的患者接受了额外2.9天的肠外抗生素治疗，住院时间延长5.3天，住院费用增加3287美元。初始抗生素治疗失败的独立危险因素为医疗保健相关感染、实体癌和急性生理与慢性健康状况评分系统（APACHE）II≥13。
为改善社区获得性cIAI患者的治疗效果和成本，应快速评估医疗保健相关危险因素和疾病严重程度，据此选择合适的抗生素方案，并尽早进行感染源控制。
