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Risk factors leading to clinical failure in the treatment of intra-abdominal or skin/soft tissue infections

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Abstract

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, includingPseudomonas 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 intraabdominal 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 includePseudomonas spp. in its spectrum when this organism is isolated from patients with such infections.

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References

  1. Bartlett JG: Intra-abdominal sepsis. Medical Clinics of North America 1995, 79: 599–617.

    PubMed  Google Scholar 

  2. Swartz MN: Cellulitis and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York, 1995, p. 909–928.

    Google Scholar 

  3. Condon RE, Wittmann DH: Approach to the patient with intra-abdominal infection. In: Gorbach SL, Bartlett JG, Blacklow NR (ed): Infectious diseases. Saunders, Philadelphia, 1992: 654–660.

    Google Scholar 

  4. Solomkin JS, Miyagawa CI: Principles of antibiotic therapy. Surgical Clinics of North America 1994, 74: 497–517.

    PubMed  Google Scholar 

  5. Gorbach SL: Antibiotic treatment of anaerobic infections. Clinical Infectious Diseases 1994,18, Supplement 4: 305.

    PubMed  Google Scholar 

  6. Thadepalli H, Gorbach SL, Broido PW, Norsen J, Nyhus L: Abdominal trauma, anaerobes and antibiotics. Surgery, Gynecology and Obstetrics 1973, 137: 270.

    Google Scholar 

  7. Heseltine PNR, Yellin AE, Appleman MD, Gill MA, Chenella FC, Kern JW, Berne TV: Perforated and gangrenous appendicitis: an analysis of antibiotic failures. Journal of Infectious Diseases 1983, 148: 322–329.

    PubMed  Google Scholar 

  8. Jaurequi LE, Applebaum PC, Fabian TC, Hageage G, Strausbaugh L, Martin LF: A randomized clinical study of cefoperazone and sulbactam versus gentamicin and clindamycin in the treatment of intra-abdominal infections. Journal of Antimicrobial Chemotherapy 1990, 25: 423–433.

    PubMed  Google Scholar 

  9. Schentag JJ, Wells PB, Reitberg DP, Walczad R Van Tyle JH: A randomized clinical trial of moxalactam alone versus tobramycin plus clindamycin in abdominal sepsis. Annals of Surgery 1983, 198: 35–41.

    PubMed  Google Scholar 

  10. Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, Adinoifi MF: Risk of infection after penetrating abdominal trauma. New England Journal of Medicine 1984, 311: 1065–1070.

    PubMed  Google Scholar 

  11. Yellin AE, Heseltine PN, Berne TV, Appleman MD, Gill MA, Riggio CE, Appelman MD, Gill MA, Riggio CE, Chenella FC: The role ofPseudomonas species in patients treated with ampicillin and sulbactam for gangrenous and perforated appendicitis. Surgery, Gynecology and Obstetrics 1985, 161: 303–307.

    Google Scholar 

  12. Ho JL, Barza M: Role of aminoglycoside antibiotics in the treatment of intra-abdominal infection. Antimicrobial Agents and Chemotherapy 1987, 31: 485–491.

    PubMed  Google Scholar 

  13. Hofstetter SR, Pacher HL, Bailey AA, Coppa GF: A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: cefoxitin vs triple drug. Journal of Trauma 1984, 24: 307–310.

    PubMed  Google Scholar 

  14. Moellering RC: Enterococcal infections in patients treated with moxalactam. Reviews of Infectious Diseases 1982, 4, Supplement: 708–711.

    Google Scholar 

  15. Burnett RJ, Haverstook DC, Dellinger EP, Reinhart HH, Bohnen JM, Rostein OD, Vogel SB, Solomkin JS: Definition of the role ofenterococcus in intra-abdominal infection: analysis of a prospective randomized trial. Surgery 1995, 118: 716–721.

    PubMed  Google Scholar 

  16. Zervos MJ, Dembry L:Enterococcus in surgical infections: virulence, epidemiology, and resistance. Infectious Disease in Clinical Practice 1994, 3, Supplement 1: 14–20.

    Google Scholar 

  17. Finegold SM, and the National Committee for Clinical Laboratory Standards Working Group on Anaerobic Susceptibility Testing: Susceptibility testing of anaerobic bacteria. Journal of Clinical Microbiology 1988, 26: 1253–1256.

    PubMed  Google Scholar 

  18. Bohen JM, Solomkin JS, Dellinger ER Bjornson HS, Page CP: Guidelines for clinical care: anti-infective agents for intra-abdominal infection. Archives of Surgery 1992, 127: 83–89.

    PubMed  Google Scholar 

  19. Fry DE: Treatment options for early intra-abdominal infection. Infectious Disease in Clinical Practice 1994, 3, Supplement 1:1–6.

    Google Scholar 

  20. Solomkin JS, Meakins JL, Allo MD, Dellinger EP, Simmons RL: Antibiotic trials in intra-abdominal infections. A critical evaluation of study design and outcome reporting. Annals of Surgery 1984, 200: 29–39.

    PubMed  Google Scholar 

  21. Nysrtom PO, Bax R, Dellinger EP, Dominioni L, Knaus WA, Meakins JL, Ohmann C, Salomkin JS, Wacha H, Wittmann DA: Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection. World Journal of Surgery 1990,14: 148–158.

    PubMed  Google Scholar 

  22. Dellinger ER, Wertz MJ, Meakins JL, Solomkin JS, Allo MD, Howard RJ, Simmons RL: Surgical infection stratification system for intra-abdominal infection. Multicenter trial. Archives of Surgery 1985, 120: 21–29.

    Google Scholar 

  23. Geckler RW, Eng RH, Fabian TC, Echols RM, Jemsek JG, LeFrock JL, Mogabgab WC, Wilson SE: A multicenter comparative study of cefotetan once daily and cefoxitin thrice daily for the treatment of the skin and superficial soft tissue. American Journal of Surgery 1988, 155, Supplement 5A: 91–95.

    PubMed  Google Scholar 

  24. Wilson SE, Boswick JA, Duma RJ, Echols RM, Jemsek JG, Lerner R, Lewis RT, Najem AZ, Press RA, Rittenbury MS: Cephalosporin therapy in intra-abdominal infections. A multicenter, randomized, comparative study of cefotetan, moxalactam, and cefoxitin. American Journal of Surgery 1988, 155, Supplement 5A: 61–66.

    PubMed  Google Scholar 

  25. Lewis RT, Duma RJ, Echols RM, Jemsek JG, Najem AZ, Press RA, Stone HH, Ton GT, Wilson SE: Comparative study of cefotetan and cefoxitin in the treatment of intra-abdominal infections. American Journal of Obstetrics and Gynecology 1988, 158: 728–735.

    PubMed  Google Scholar 

  26. Walker AP, Nichols RL, Wilson RF, Bivens BA, Trunkey DD, Edmiston CE, Smith JW, Condon RE: Efficacy of a beta-lactamase inhibitor combination for serious intraabdominal infections. Annals of Surgery 1993, 217: 115–121.

    PubMed  Google Scholar 

  27. Solomkin JS, Hemsell DL, Sweet R, Tally F, Bartlett JG: Evaluation of new anti-infective drugs for the treatment of intra-abdominal infections. Clinical Infectious Diseases 1992, 15, Supplement 1: 33–42.

    PubMed  Google Scholar 

  28. Calandra GB, Norden C, Nelson JD, Mader JT: Evaluation of new anti-infective drugs for the treatment of selected infections of the skin and skin structure. Clinical Infectious Diseases 1992, 15, Supplement 1: 148–154.

    Google Scholar 

  29. Snydman DR, Cuchural GJ, McDermott L, Gill M: Correlation of various in vitro testing methods with clinical outcomes in patients withBacteroides fragilis group infections treated with cefoxitin. A retrospective analysis. Antimicrobial Agents and Chemotherapy 1992, 36: 540–544.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, New England Medical Center, and Tufts University School of Medicine, 750 Washington Street, Box 238, 02111, Boston, Massachusetts, USA

    M. E. Falagas, L. Barefoot & D. R. Snydman

  2. Division of Clinical Care Research, Department of Medicine, New England Medical Center, and Tufts University School of Medicine, 750 Washington Street, Box 238, 02111, Boston, Massachusetts, USA

    J. Griffith & R. Ruthazar

  3. Clinical Microbiology Laboratory, Department of Pathology, New England Medical Center, and Tufts University School of Medicine, 750 Washington Street, Box 238, 02111, Boston, Massachusetts, USA

    D. R. Snydman

Authors
  1. M. E. Falagas
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  2. L. Barefoot
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  4. R. Ruthazar
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  5. D. R. Snydman
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Falagas, M.E., Barefoot, L., Griffith, J. et al. Risk factors leading to clinical failure in the treatment of intra-abdominal or skin/soft tissue infections. Eur. J. Clin. Microbiol. Infect. Dis. 15, 913–921 (1996). https://doi.org/10.1007/BF01690508

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