Diaz Jose J, Zielinski Martin D, Chipman Amanda M, O'Meara Lindsay, Schroeppel Thomas, Cullinane Daniel, Shoultz Thomas, Barnes Stephen L, May Addison K, Maung Adrian A
From the University of Maryland Medical Center, Baltimore, MD (Diaz, Chipman, O'Meara).
Mayo Clinic, Rochester, MN (Zielinski).
J Am Coll Surg. 2022 Apr 1;234(4):419-427. doi: 10.1097/XCS.0000000000000126.
Data on duration of antibiotics in patients managed with an open abdomen (OA) due to intra-abdominal infection (IAI) are scarce. We hypothesized that patients with IAI managed with OA rather than closed abdomen (CA) would have higher rates of secondary infections (SIs) independent of the duration of the antibiotic treatment.
This was an observational, prospective, multicenter, international study of patients with IAI requiring laparotomy for source control. Demographic and antibiotic duration values were collected. Primary outcomes were SI (surgical site, bloodstream, pneumonia, urinary tract) and mortality. Statistical analysis included ANOVA, chi-square/Fisher's exact test, and logistic regression.
Twenty-one centers contributed 752 patients. The average age was 59.6 years, 43.6% were women, and 43.9% were managed with OA. Overall mortality was 16.1%, with higher rates among OA patients (31.6% vs 4.4%, p < 0.001). OA patients had higher Sequential Organ Failure Assessment (4.7 vs 1.8, p < 0.001), American Society of Anesthesiologists Physical Status (3.6 vs 2.7, p < 0.001), and APACHE II scores (16.1 vs 9.4, p < 0.001). The mean duration of antibiotics was 6.5 days (8.0 OA vs 5.4 CA, p < 0.001). A total of 179 (23.8%) patients developed SI (33.1% OA vs 16.8% CA, p < 0.001). Longer antibiotic duration was associated with increased rates of SI: 1 to 2 days, 15.8%; 3 to 5 days, 20.4%; 6 to 14 days, 26.6%; and more than 14 days, 46.8% (p < 0.001).
Patients with IAI managed with OA had higher rates of SI and increased mortality compared with CA. A prolonged duration of antibiotics was associated with increased rates of SI. Increased antibiotic duration is not associated with improved outcomes in patients with IAI and OA.
关于因腹腔内感染（IAI）而接受开放性腹腔（OA）治疗的患者使用抗生素的时长数据稀缺。我们推测，因IAI接受OA治疗而非闭合性腹腔（CA）治疗的患者，其继发感染（SI）发生率更高，且与抗生素治疗时长无关。
这是一项针对因IAI需剖腹手术以控制感染源的患者的观察性、前瞻性、多中心国际研究。收集了人口统计学和抗生素使用时长数据。主要结局为SI（手术部位、血流、肺炎、尿路感染）和死亡率。统计分析包括方差分析、卡方检验/费舍尔精确检验以及逻辑回归。
21个中心纳入了752例患者。平均年龄为59.6岁，43.6%为女性，43.9%接受OA治疗。总体死亡率为16.1%，OA患者的死亡率更高（31.6%对4.4%，p<0.001）。OA患者的序贯器官衰竭评估评分更高（4.7对1.8，p<0.001），美国麻醉医师协会身体状况评分更高（3.6对2.7，p<0.001），急性生理学及慢性健康状况评分系统II（APACHE II）评分更高（16.1对9.4，p<0.001）。抗生素的平均使用时长为6.5天（OA组为8.0天，CA组为5.4天，p<0.001）。共有179例（23.8%）患者发生SI（OA组为33.1%，CA组为16.8%，p<0.001）。抗生素使用时长越长，SI发生率越高：1至2天，15.8%；3至5天，20.4%；6至14天，26.6%；超过14天，46.8%（p<0.001）。
与CA治疗相比，因IAI接受OA治疗的患者SI发生率更高，死亡率也更高。抗生素使用时长延长与SI发生率增加相关。抗生素使用时长增加与IAI和OA患者的预后改善无关。
