Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis 英文参考文献.docVIP

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Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis 英文参考文献.doc

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Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis 英文参考文献

Augustinetal.CriticalCare2010,14:R20 /content/14/1/R20 RESEARCH OpenAccess Riskfactorsformultidrugresistantbacteriaand optimizationofempiricalantibiotictherapyin postoperativeperitonitis PascalAugustin1*,NathalieKermarrec1,ClaudetteMuller-Serieys2,SigismondLasocki1,DenisChosidow3, Jean-PierreMarmuse3,NadiaValin4,Jean-MarieDesmonts1,PhilippeMontravers1 Abstract Introduction:Themainobjectivewastodetermineriskfactorsforpresenceofmultidrugresistantbacteria(MDR) inpostoperativeperitonitis(PP)andoptimalempiricalantibiotictherapy(EA)amongoptionsproposedby InfectiousDiseaseSocietyofAmericaandtheSurgicalInfectionSocietyguidelines. Methods:Onehundredpatientshospitalisedintheintensivecareunit(ICU)forPPwerereviewed.Clinicaland microbiologicdata,EAanditsadequacywereanalysed.Theinvitroactivitiesof9antibioticsinrelationtothe culturedbacteriawereassessedtoproposethemostadequateEAamong17regimensinthelargestnumberof cases. Results:Atotalof269bacteriawasculturedin100patientsincluding41episodeswithMDR.Accordingtologistic regressionanalysis,theuseofbroad-spectrumantibioticbetweeninitialinterventionandreoperationwastheonly significantriskfactorforemergenceofMDRbacteria(oddsratio(OR)=5.1;95%confidenceinterval(CI)=1.7-15; P=0.0031).Antibioticsprovidingthebestactivityratewereimipenem/cilastatin(68%)andpiperacillin/tazobactam (53%).ThebestadequacyforEAwasobtainedbycombinationsofimipenem/cilastatinorpiperacillin/tazobactam, amikacinandaglycopeptide,withvaluesreaching99%and94%,respectively.Imipenem/cilastinwastheonly single-drugregimenprovidinganadequacysuperiorto80%intheabsenceofbroadspectrumantibioticbetween initialsurgeryandreoperation. Conclusions:IntervalantibiotictherapyisassociatedwiththepresenceofMDRbacteria.Notallregimens proposedbyInfectiousDiseaseSocietyofAmericaandtheSurgicalInfectionSocietyguidelinesforPPcanprovide anacceptablerateofadequacy.Monotherapywithimipenem/cilastinissuitableforEAonlyinabsenceofthisrisk factorforMDR.Forotherpatients,onlyantibioticcombinationsmayachievehi