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Outcome analysis of intraabdominal infection with resistant gram-positive organisms
Shawn J Pelletier1, Daniel P Raymond, Traves D Crabtree
1Department of Surgery, Room 3150, MR4, Lane Road, University of Virginia Health Systems, Charlottesville, VA 22908, USA. sjp7t@virginia.edu
Background:
Although the microbiology of intraabdominal infection has been well described, the role of resistant organisms remains unclear. To evaluate the hypothesis that intraabdominal infections from resistant gram-positive cocci (rGPC) have worse outcomes compared to those with susceptible organisms, patient characteristics and outcomes were compared between these groups.
Methods:
Analysis of peritoneal infections was performed on prospectively collected data of all consecutive surgical infections from December 1996 to June 1999 at a university hospital. Intraabdominal infection was defined either by a positive peritoneal cavity culture or on clinical grounds (e.g., abscess), which prompted antimicrobial or surgical therapy. Resistant Staphylococcus and Enterococcus spp. were defined as those strains resistant to oxacillin, gentamicin, or vancomycin.
Results:
Compared to episodes of intraabdominal infection from susceptible organisms (n = 365), infections due to rGPC (n = 52) were associated with an increased severity of illness (p < 0.0001), longer time from admission to treatment (p < 0.0001), longer duration of therapy (p = 0.008), greater proportion of nosocomial infection (p < 0.0001), increased length of stay (p < 0.0001), and an increased mortality rate (9% versus 23%; p = 0.003). However, comparison of intraabdominal infection with rGPC to a group controlled for severity of illness demonstrated a prolonged time from admission until treatment and longer duration of hospitalization but a similar mortality rate between groups (17% versus 23%; p = 0.46).
Conclusion:
Intraabdominal infection with rGPC is an indicator of poor prognosis and severe illness. Although not an independent predictor of mortality, the significantly increased duration of therapy and prolonged duration of hospitalization may have considerable economic impact.
Insights
Intraabdominal infections caused by resistant gram-positive cocci (rGPC) indicate severe illness and poorer prognosis. While not independently predicting mortality, these infections significantly increase healthcare costs due to longer treatment and hospital stays.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Surgical Infections
Background:
- The role of resistant organisms in intraabdominal infections (IAI) is not well understood.
- Investigating outcomes of IAIs caused by resistant gram-positive cocci (rGPC) versus susceptible organisms.
Purpose of the Study:
- To evaluate if IAIs caused by rGPC are associated with worse patient outcomes compared to infections with susceptible organisms.
- To analyze patient characteristics and outcomes in IAIs caused by resistant versus susceptible pathogens.
Main Methods:
- Prospective analysis of peritoneal infections from surgical cases (1996-1999).
- IAI defined by positive culture or clinical signs requiring treatment.
- Resistant Staphylococcus and Enterococcus spp. defined by resistance to oxacillin, gentamicin, or vancomycin.
Main Results:
- Infections due to rGPC (n=52) showed increased illness severity, longer treatment times, higher nosocomial infection rates, and longer hospital stays compared to susceptible organisms (n=365).
- Mortality rate was higher in rGPC infections (23%) versus susceptible organisms (9%).
- After controlling for illness severity, rGPC infections still showed prolonged treatment and hospitalization but similar mortality rates.
Conclusions:
- Intraabdominal infection with rGPC signifies severe illness and a poor prognosis.
- rGPC is not an independent predictor of mortality but leads to increased therapy duration and hospitalization.
- Prolonged treatment and hospitalization for rGPC infections have significant economic implications.