Risk factors for multidrug-resistant bacteria in patients with post-operative peritonitis requiring intensive care

• Published in: Journal of antimicrobial chemotherapy 2010-02, Vol.65 (2), p.342-346
• Main Authors: Seguin, Philippe, Fédun, Yannick, Laviolle, Bruno, Nesseler, Nicolas, Donnio, Pierre-Yves, Mallédant, Yannick
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Amikacin; Amoxicillin; Anti-Bacterial Agents; Anti-Bacterial Agents - pharmacology; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; antimicrobial therapy; Bacteria; Bacteria - drug effects; Bacteria - isolation & purification; Bacterial Infections; Bacterial Infections - microbiology; Biological and medical sciences; Blood culture; Cefepime; Cefotaxime; Ceftazidime; Ciprofloxacin; Clavulanic acid; Critical Care; Diffusion; Drug resistance; Drug Resistance, Multiple, Bacterial; empirical therapy; Erythromycin; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gentamicin; Gram-negative bacteria; Gram-positive bacteria; Hospitals; Humans; Imipenem; in vitro susceptibility; Intensive Care; Intensive care units; Life Sciences; Male; Medical sciences; Microbial Sensitivity Tests; Microbiology and Parasitology; Microorganisms; Middle Aged; Mortality; Multivariate analysis; Other diseases. Semiology; Oxacillin; peritoneal fluid; Peritonitis; Peritonitis - microbiology; Pharmacology. Drug treatments; Piperacillin; Risk Factors; Studies; surgery; Surgical Wound Infection; Surgical Wound Infection - microbiology; Tazobactam; Therapy; ticarcillin; Vancomycin
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkp439

Objectives This prospective non-interventional study investigated the risk factors for multidrug-resistant bacteria (MDRB) in patients with post-operative peritonitis (POP), to provide guidance for empirical antimicrobial therapy. Methods All consecutive patients, >15 years old, admitted to a surgical intensive care unit (ICU) between September 2006 and January 2009 for a first episode of POP were included. Antibiotic susceptibilities of microorganisms recovered from blood cultures and peritoneal fluid were determined by disc diffusion. Amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, gentamicin, amikacin and ciprofloxacin were tested against Gram-negative bacteria, and oxacillin, amoxicillin, vancomycin, gentamicin and erythromycin were tested against aerobic Gram-positive bacteria. Results were reported as susceptible or resistant. Results MDRB were isolated from 20/115 (17%) patients. In univariate analysis, use of antimicrobial therapy during the 3 months prior to hospitalization and a long duration between hospital admission or first operation and relaparotomy were significantly associated with MDRB recovery. In multivariate analysis, only antimicrobial treatment in the 3 months preceding hospitalization and duration between first operation and relaparotomy were independent risk factors for MDRB [odds ratio (OR) = 5.80, 95% confidence interval (95% CI) = 1.99−16.91 and OR = 1.10, 95% CI = 1.02−1.19, respectively]. No MDRB were found when the delay between the first operation and relaparotomy was 5 days between the first operation and relaparotomy.