原创力文档risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis耐药细菌的风险因素和优化的经验性抗生素治疗术后腹膜炎.pdfVIP
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risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis耐药细菌的风险因素和优化的经验性抗生素治疗术后腹膜炎
Augustin et al. Critical Care 2010, 14:R20
/content/14/1/R20
RESEARCH Open Access
Risk factors for multidrug resistant bacteria and
optimization of empirical antibiotic therapy in
postoperative peritonitis
1* 1 2 1 3
Pascal Augustin , Nathalie Kermarrec , Claudette Muller-Serieys , Sigismond Lasocki , Denis Chosidow ,
Jean-Pierre Marmuse3 4 1 1
, Nadia Valin , Jean-Marie Desmonts , Philippe Montravers
Abstract
Introduction: The main objective was to determine risk factors for presence of multidrug resistant bacteria (MDR)
in postoperative peritonitis (PP) and optimal empirical antibiotic therapy (EA) among options proposed by
Infectious Disease Society of America and the Surgical Infection Society guidelines.
Methods: One hundred patients hospitalised in the intensive care unit (ICU) for PP were reviewed. Clinical and
microbiologic data, EA and its adequacy were analysed. The in vitro activities of 9 antibiotics in relation to the
cultured bacteria were assessed to propose the most adequate EA among 17 regimens in the largest number of
cases.
Results: A total of 269 bacteria was cultured in 100 patients including 41 episodes with MDR. According to logistic
regression analysis, the use of broad-spectrum antibiotic between initial intervention and reoperation was the only
significant risk factor for emergence of MDR bacteria (odds ratio (OR) = 5.1; 95% confidence interval (CI) = 1.7 - 15;
P = 0.0031). Antibiotics providing the best activity rate were imipenem/cilastatin (68%) and piperacillin/tazobactam
(53%). The best adequacy for EA was obtained by combinations of imipenem/cilastatin or pi
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