Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment

Detalhes bibliográficos
Autor(a) principal: Silva-Nunes, J.
Data de Publicação: 2019
Outros Autores: Cardoso, Teresa
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.16/2358
Resumo: The study was approved by the local ethics committee, Departamento de Ensino, Formação e Investigação (DEFI) of Centro Hospitalar Universitário do Porto (CHUP) - ref. 2017.226(195-DEFI/187-CES). The need for consent was waived by the local ethics committee and patient data was de-identified
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spelling Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatmentAntibiotic therapyClassificationHospital mortalityIntra-abdominal infectionsThe study was approved by the local ethics committee, Departamento de Ensino, Formação e Investigação (DEFI) of Centro Hospitalar Universitário do Porto (CHUP) - ref. 2017.226(195-DEFI/187-CES). The need for consent was waived by the local ethics committee and patient data was de-identifiedBackground: Intra-abdominal infections (IAIs) represent a most frequent gastrointestinal emergency and serious cause of morbimortality. A full classification, including all facets of IAIs, does not exist. Two classifications are used to subdivide IAIs: uncomplicated or complicated, considering infection extent; and community-acquired, healthcare-associated or hospital-acquired, regarding the place of acquisition. Adequacy of initial empirical antibiotic therapy prescribed is an essential need. Inadequate antibiotic therapy is associated with treatment failure and increased mortality. This study was designed to determine accuracy of different classifications of IAIs to identify infections by pathogens sensitive to current treatment guidelines helping the selection of the best antibiotic therapy. Methods: A retrospective cohort study including all adult patients discharged from hospital with a diagnosis of IAI between 1st of January and 31st of October, 2016. All variables potentially associated with pre-defined outcomes: infection by a pathogen sensitive to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (ATB 1, primary outcome), sensitive to piperacillin-tazobactam (ATB 2) and hospital mortality (secondary outcomes) were studied through logistic regression. Accuracy of the models was assessed by area under receiver operating characteristics (AUROC) curve and calibration was tested using the Hosmer-Lemeshow goodness-of-fit test. Results: Of 1804 patients screened 154 met inclusion criteria. Sensitivity to ATB 1 was independently associated with male gender (adjusted OR = 2.612) and previous invasive procedures in the last year (adjusted OR = 0.424) (AUROC curve = 0,65). Sensitivity to ATB 2 was independently associated with liver disease (adjusted OR = 3.580) and post-operative infections (adjusted OR = 2.944) (AUROC curve = 0.604). Hospital mortality was independently associated with age ≥ 70 (adjusted OR = 4.677), solid tumour (adjusted OR = 3.127) and sensitivity to non-pseudomonal cephalosporin or ciprofloxacin plus metronidazole (adjusted OR = 0.368). The accuracy of pre-existing classifications to identify infection by a pathogen sensitive to ATB 1 was 0.59 considering place of acquisition, 0.61 infection extent and 0.57 local of infection, for ATB 2 it was 0.66, 0.50 and 0.57, respectively. Conclusion: None of existing classifications had a good discriminating power to identify IAIs caused by pathogens sensitive to current antibiotic treatment recommendations. A new classification, including patients' individual characteristics like those included in the current model, might have a higher potential to distinguish IAIs by resistant pathogens allowing a better choice of empiric antibiotic therapy.BMCRepositório Científico do Centro Hospitalar Universitário de Santo AntónioSilva-Nunes, J.Cardoso, Teresa2020-05-04T22:49:16Z2019-11-212019-11-21T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2358engSilva-Nunes J, Cardoso T. Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment. BMC Infect Dis. 2019;19(1):980. Published 2019 Nov 21. doi:10.1186/s12879-019-4604-01471-233410.1186/s12879-019-4604-0info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T11:00:28Zoai:repositorio.chporto.pt:10400.16/2358Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:34.005967Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
title Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
spellingShingle Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
Silva-Nunes, J.
Antibiotic therapy
Classification
Hospital mortality
Intra-abdominal infections
title_short Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
title_full Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
title_fullStr Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
title_full_unstemmed Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
title_sort Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment
author Silva-Nunes, J.
author_facet Silva-Nunes, J.
Cardoso, Teresa
author_role author
author2 Cardoso, Teresa
author2_role author
dc.contributor.none.fl_str_mv Repositório Científico do Centro Hospitalar Universitário de Santo António
dc.contributor.author.fl_str_mv Silva-Nunes, J.
Cardoso, Teresa
dc.subject.por.fl_str_mv Antibiotic therapy
Classification
Hospital mortality
Intra-abdominal infections
topic Antibiotic therapy
Classification
Hospital mortality
Intra-abdominal infections
description The study was approved by the local ethics committee, Departamento de Ensino, Formação e Investigação (DEFI) of Centro Hospitalar Universitário do Porto (CHUP) - ref. 2017.226(195-DEFI/187-CES). The need for consent was waived by the local ethics committee and patient data was de-identified
publishDate 2019
dc.date.none.fl_str_mv 2019-11-21
2019-11-21T00:00:00Z
2020-05-04T22:49:16Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.16/2358
url http://hdl.handle.net/10400.16/2358
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Silva-Nunes J, Cardoso T. Intra-abdominal infections: the role of different classifications on the selection of the best antibiotic treatment. BMC Infect Dis. 2019;19(1):980. Published 2019 Nov 21. doi:10.1186/s12879-019-4604-0
1471-2334
10.1186/s12879-019-4604-0
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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