Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France.
Service de Chirurgie digestive, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France.
Surg Infect (Larchmt). 2020 Apr;21(3):284-292. doi: 10.1089/sur.2019.120. Epub 2019 Nov 26.
Empirical antibiotherapy (EA) should target all bacteria in post-operative peritonitis (PP). Nevertheless, recent studies failed to prove a link between adequacy of EA and prognosis of PP. We sought to confirm this loss of association between adequate EA and prognosis and to analyze the evolution of patients' characteristics and antimicrobial strategies. This is was retrospective study. Patients with a positive fungal culture were excluded. The cohort was divided into two time periods. Data of survivors and non-survivors were compared within each time period. Differences between the two periods were assessed. A multivariable analysis searched for parameters associated with a higher hospital mortality rate. Two hundred fifty-one patients were included, with 92 patients in the first period (P1) and 152 patients in the second period (P2). Inadequate EA was associated with a worse outcome only in P1. The multivariable analysis in the whole cohort showed that inadequate EA was associated with a higher mortality rate. When the differences noticed between the two periods were entered in the model (presence of resistant gram-positive cocci and EA comprising glycopeptides), inadequate EA was no longer associated with worse outcome. In P1, the most severe patients had more resistant bacteria, hence, had a higher rate of inadequate EA. This artifact disappeared in P2, during which broader antibiotherapies with triple EA were more often prescribed for the most severe patients. This study showed that the link between inadequate EA and outcome of patients with PP was at least partly artifactual in older studies.
经验性抗生素治疗（EA）应针对术后腹膜炎（PP）中的所有细菌。然而，最近的研究未能证明 EA 的充分性与 PP 的预后之间存在关联。我们试图证实 EA 的充分性与预后之间这种关联的丧失，并分析患者特征和抗菌策略的演变。这是一项回顾性研究。排除真菌培养阳性的患者。将队列分为两个时期。比较每个时期的幸存者和非幸存者的数据。评估两个时期之间的差异。多变量分析寻找与更高的医院死亡率相关的参数。共纳入 251 例患者，其中第一期（P1）92 例，第二期（P2）152 例。仅在 P1 中，EA 不充分与较差的预后相关。整个队列的多变量分析显示，EA 不充分与更高的死亡率相关。当模型中纳入两个时期之间注意到的差异（存在耐药革兰阳性球菌和包含糖肽的 EA）时，EA 不充分不再与较差的预后相关。在 P1 中，病情最严重的患者有更多的耐药菌，因此，EA 不充分的发生率更高。这种人为因素在 P2 中消失，在此期间，针对病情最严重的患者更常开具更广泛的包含三种药物的 EA 治疗。这项研究表明，在以前的研究中，EA 不充分与 PP 患者预后之间的关联至少部分是人为的。
