Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death: A study of 2,552 consecutive infections

Lin M. Riccio, Kimberley A. Popovsky, Tjasa Hranjec, Amani Politano, Laura H. Rosenberger, Kristin C. Tura, Robert G. Sawyer

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Abstract

We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. Methods: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ2 analysis, Wilcoxon rank sum test, and multi-variable analysis. Results: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). Conclusions: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.

Original languageEnglish (US)
Pages (from-to)417-424
Number of pages8
JournalSurgical Infections
Volume15
Issue number4
DOIs
StatePublished - Aug 1 2014
Externally publishedYes

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Intraabdominal Infections
Anti-Bacterial Agents
Infection
APACHE
Therapeutics
Nonparametric Statistics
Mortality
Hospital Mortality

ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

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Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death : A study of 2,552 consecutive infections. / Riccio, Lin M.; Popovsky, Kimberley A.; Hranjec, Tjasa; Politano, Amani; Rosenberger, Laura H.; Tura, Kristin C.; Sawyer, Robert G.

In: Surgical Infections, Vol. 15, No. 4, 01.08.2014, p. 417-424.

Research output: Contribution to journalArticle

Riccio, Lin M. ; Popovsky, Kimberley A. ; Hranjec, Tjasa ; Politano, Amani ; Rosenberger, Laura H. ; Tura, Kristin C. ; Sawyer, Robert G. / Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death : A study of 2,552 consecutive infections. In: Surgical Infections. 2014 ; Vol. 15, No. 4. pp. 417-424.
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abstract = "We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. Methods: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ2 analysis, Wilcoxon rank sum test, and multi-variable analysis. Results: We identified 2,552 IAI, of which 549 (21.5{\%}) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1{\%} vs. 5.4{\%}, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3{\%}, vs. 25.1{\%} in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9{\%} vs. 9.0{\%}, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). Conclusions: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.",
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AU - Hranjec, Tjasa

AU - Politano, Amani

AU - Rosenberger, Laura H.

AU - Tura, Kristin C.

AU - Sawyer, Robert G.

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N2 - We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. Methods: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ2 analysis, Wilcoxon rank sum test, and multi-variable analysis. Results: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). Conclusions: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.

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