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Published on: December 18, 2010
Do Polymicrobial Intra-Abdominal Infections Have Worse Outcomes than Monomicrobial Intra-Abdominal Infections?
Puja M Shah1, Brandy L Edwards1, Zachary C Dietch1
11 Department of Surgery, University of Virginia , Charlottesville, Virginia.
Background:
Numerous studies have demonstrated microorganism interaction through signaling molecules, some of which are recognized by other bacterial species. This interspecies synergy can prove detrimental to the human host in polymicrobial infections. We hypothesized that polymicrobial intra-abdominal infections (IAI) have worse outcomes than monomicrobial infections.
Methods:
Data from the Study to Optimize Peritoneal Infection Therapy (STOP-IT), a prospective, multicenter, randomized controlled trial, were reviewed for all occurrences of IAI having culture results available. Patients in STOP-IT had been randomized to receive four days of antibiotics vs. antibiotics until two days after clinical symptom resolution. Patients with polymicrobial and monomicrobial infections were compared by univariable analysis using the Wilcoxon rank sum, χ(2), and Fisher exact tests.
Results:
Culture results were available for 336 of 518 patients (65%). The durations of antibiotic therapy in polymicrobial (n = 225) and monomicrobial IAI (n = 111) were equal (p = 0.78). Univariable analysis demonstrated similar demographics in the two populations. The 37 patients (11%) with inflammatory bowel disease were more likely to have polymicrobial IAI (p = 0.05). Polymicrobial infections were not associated with a higher risk of surgical site infection, recurrent IAI, or death.
Conclusion:
Contrary to our hypothesis, polymicrobial IAI do not have worse outcomes than monomicrobial infections. These results suggest polymicrobial IAI can be treated the same as monomicrobial IAI.
Insights
Polymicrobial intra-abdominal infections (IAI) do not lead to worse patient outcomes compared to monomicrobial IAI. These findings suggest similar treatment approaches for both types of IAI.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgical Infections
Background:
- Microorganism signaling molecules mediate interspecies synergy, potentially harming hosts in polymicrobial infections.
- Polymicrobial infections involve interactions between multiple microbial species.
- Intra-abdominal infections (IAI) can be either monomicrobial or polymicrobial.
Purpose of the Study:
- To test the hypothesis that polymicrobial intra-abdominal infections (IAI) have worse outcomes than monomicrobial IAI.
- To compare patient outcomes between polymicrobial and monomicrobial IAI.
Main Methods:
- Utilized data from the prospective, multicenter Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial.
- Compared patients with polymicrobial IAI (n=225) and monomicrobial IAI (n=111) using univariable analysis.
- Analyzed culture results from 336 of 518 patients (65%) with IAI.
Main Results:
- Polymicrobial and monomicrobial IAI groups had similar durations of antibiotic therapy.
- No significant difference in demographics was observed between the two groups.
- Polymicrobial IAI were not associated with increased risk of surgical site infection, recurrent IAI, or death.
Conclusions:
- Contrary to the initial hypothesis, polymicrobial IAI did not demonstrate worse outcomes than monomicrobial infections.
- The findings suggest that polymicrobial IAI can be treated similarly to monomicrobial IAI.
- Further research may explore the specific mechanisms of interspecies synergy in IAI.
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