Department of Pharmacy, Methodist Dallas Medical Center, Dallas, Texas.
Organ Transplant Infectious Diseases, Methodist Transplant Specialists, Methodist Dallas Medical Center, Dallas, Texas.
Surg Infect (Larchmt). 2019 Dec;20(8):650-657. doi: 10.1089/sur.2018.317. Epub 2019 Jun 5.
Optimal treatment of intra-abdominal infections (IAIs) is multifaceted, typically requiring surgical intervention and antimicrobial therapy. Treatment of IAIs aligned with the 2017 revised Surgical Infection Society (SIS) guidelines may improve patient outcomes. Here we compare clinical outcomes of patients who received guideline concordant and discordant therapy for treatment of IAIs. This was a retrospective observational study of patients admitted from January 2013 to June 2016 with IAIs. Guideline concordant treatment was based on three criteria: source control, antibiotic choice, and antibiotic duration. The primary outcome was a composite of in-hospital mortality and 30-day re-admission. Multivariable logistic regression was used to determine independent factors associated with the composite end point. A total of 221 patients were included, with guideline concordant treatment occurring in 117 (53%) patients. In-hospital mortality or 30-day re-admission occurred in 15 (12.8%) patients in the guideline concordant group compared with 24 (23.1%) in the guideline discordant group (p = 0.046). Empiric antibiotic choice was the most common component of discordance to guidelines (61% of patients). In multivariable analysis, guideline concordant treatment was associated with a decrease in the composite outcome (adjusted odds ratio [aOR] = 0.461, p = 0.045). In contrast, the presence of empiric methicillin-resistant (MRSA)/vancomycin-resistant (VRE) coverage (aOR: 2.645, p = 0.030), and moderate-to-severe liver disease (aOR: 8.081, p = 0.027) were associated with an increased risk for the composite outcome. Concordance to recommendations from the 2017 revised SIS guidelines is of critical importance in the optimal management of IAIs and further investigation of interventions to improve concordance are warranted.
优化治疗腹腔内感染（IAIs）是多方面的，通常需要手术干预和抗菌治疗。根据 2017 年修订的外科感染学会（SIS）指南进行 IAI 治疗可能会改善患者的预后。在这里，我们比较了接受指南一致和不一致治疗的 IAI 患者的临床结果。
这是一项回顾性观察性研究，纳入了 2013 年 1 月至 2016 年 6 月期间因 IAI 入院的患者。指南一致的治疗是基于三个标准：源头控制、抗生素选择和抗生素持续时间。主要结局是住院死亡率和 30 天再入院的复合结局。多变量逻辑回归用于确定与复合终点相关的独立因素。
共纳入 221 例患者，其中 117 例（53%）接受了指南一致的治疗。在指南一致组中，有 15 例（12.8%）患者发生住院死亡率或 30 天再入院，而在指南不一致组中，有 24 例（23.1%）患者发生住院死亡率或 30 天再入院（p=0.046）。经验性抗生素选择是最常见的不符合指南的因素（61%的患者）。多变量分析显示，指南一致的治疗与复合结局的降低相关（调整后的优势比[aOR] = 0.461，p=0.045）。相比之下，经验性耐甲氧西林金黄色葡萄球菌（MRSA）/万古霉素耐药肠球菌（VRE）覆盖（aOR：2.645，p=0.030）和中重度肝功能不全（aOR：8.081，p=0.027）与复合结局的风险增加相关。
2017 年修订的 SIS 指南建议的一致性对于 IAI 的最佳管理至关重要，进一步研究提高一致性的干预措施是必要的。
