Falagas M E, Barefoot L, Griffith J, Ruthazar R, Snydman D R
Division of Infectious Diseases, New England Medical Center, Boston, Massachusetts, USA.
Eur J Clin Microbiol Infect Dis. 1996 Dec;15(12):913-21. doi: 10.1007/BF01690508.
A study of determinants of outcome in adult patients with intra-abdominal or skin/soft tissue infections treated with cefotetan, cefoxitin, or ampicillin/sulbactam monotherapy was undertaken. Patients were matched for principal infectious process, surgery performed for the management of the infection, year of hospital admission, age, and sex. The criteria for inclusion, exclusion, and matching of patients and assignment of clinical and microbiological outcome were based on the 1992 Infectious Diseases Society of America/Federal Drug Administration guidelines for the evaluation of anti-infective drug products. One hundred and thirty-seven cases of intra-abdominal or skin and soft tissue infections treated with cefotetan (n = 47), cefoxitin (n = 43), or ampicillin/sulbactam (n = 47) monotherapy were selected without knowledge of outcome and analyzed using a single blinded analysis. The baseline characteristics did not differ between the treatment groups, nor did the rates of clinical or microbiological failure. A multivariate analysis showed that isolation of an organism resistant to the treatment regimen, including Pseudomonas spp., [odds ratio (OR) = 14.9, p = 0.001], being on antibiotic therapy at the time of admission (OR = 4.5, p = 0.007), and diagnosis of a complicated intra-abdominal infection (OR = 3.5, p = 0.014) were independently associated with clinical failure. These data support the assertion that antibiotic resistant organisms in mixed anaerobic/aerobic infections are associated with clinical failure and suggest that the antibiotic regimen should be modified to include Pseudomonas spp. in its spectrum when this organism is isolated from patients with such infections.
开展了一项关于接受头孢替坦、头孢西丁或氨苄西林/舒巴坦单药治疗的成年腹腔内或皮肤/软组织感染患者结局决定因素的研究。患者在主要感染过程、为控制感染而进行的手术、入院年份、年龄和性别方面进行了匹配。患者的纳入、排除和匹配标准以及临床和微生物学结局的判定基于1992年美国传染病学会/联邦药物管理局评估抗感染药物产品的指南。在不了解结局的情况下，选择了137例接受头孢替坦（n = 47）、头孢西丁（n = 43）或氨苄西林/舒巴坦（n = 47）单药治疗的腹腔内或皮肤及软组织感染病例，并采用单盲分析进行分析。各治疗组之间的基线特征以及临床或微生物学失败率均无差异。多变量分析显示，分离出对治疗方案耐药的微生物，包括假单胞菌属（优势比[OR]=14.9，p = 0.001）、入院时接受抗生素治疗（OR = 4.5，p = 0.007）以及诊断为复杂性腹腔内感染（OR = 3.5，p = 0.014）与临床失败独立相关。这些数据支持了以下观点：混合需氧/厌氧菌感染中的抗生素耐药微生物与临床失败相关，并表明当从此类感染患者中分离出该微生物时，应调整抗生素方案，使其抗菌谱包括假单胞菌属。
