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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative

Pascal Augustin1, Nathalie Kermarrec, Claudette Muller-Serieys

  • 1Department of Anesthesiology and Surgical Intensive Care Unit, Hôpital Bichat-Claude Bernard, Université Paris VII Denis Diderot, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. pascalaugustin@hotmail.com

Critical Care (London, England)
|February 17, 2010
PubMed
Abstract

Insights

Interval antibiotic therapy increases the risk of multidrug-resistant (MDR) bacteria in postoperative peritonitis (PP). Combinations of antibiotics are often needed for optimal empirical antibiotic therapy (EA), except for imipenem/cilastatin in specific cases.

Area of Science:

  • Infectious Diseases
  • Surgical Infections
  • Pharmacology

Background:

  • Postoperative peritonitis (PP) presents a significant challenge in intensive care units (ICUs).
  • The emergence of multidrug-resistant (MDR) bacteria complicates treatment strategies for PP.
  • Identifying risk factors for MDR and optimizing empirical antibiotic therapy (EA) are crucial for patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with MDR bacteria in patients with PP.
  • To evaluate the adequacy of proposed empirical antibiotic therapy (EA) regimens.
  • To determine the most effective EA strategies based on in vitro antibiotic activity.

Main Methods:

  • A retrospective review of 100 ICU patients with PP was conducted.
  • Clinical and microbiological data, including EA and its adequacy, were analyzed.
  • In vitro activity of 9 antibiotics against cultured bacteria was assessed to propose optimal EA regimens.

Main Results:

  • The use of broad-spectrum antibiotics between initial surgery and reoperation was the sole significant risk factor for MDR emergence (OR=5.1).
  • Imipenem/cilastatin (68%) and piperacillin/tazobactam (53%) showed the highest in vitro activity rates.
  • EA combinations including imipenem/cilastatin or piperacillin/tazobactam, amikacin, and a glycopeptide achieved high adequacy rates (99% and 94%).

Conclusions:

  • Antibiotic therapy during the interval between surgical interventions is linked to the presence of MDR bacteria.
  • Not all guideline-recommended EA regimens for PP ensure adequate coverage.
  • Monotherapy with imipenem/cilastatin is appropriate for EA only when the risk factor for MDR is absent; otherwise, antibiotic combinations are necessary.

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