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Published on: December 18, 2010
Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999-2019
Philippe Montravers1,2,3, Nathalie Grall4,5, Elie Kantor6
1Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France. philippe.montravers@aphp.fr.
Background:
Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT).
Methods:
This retrospective monocentric analysis (1999-2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO.
Results:
A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time.
Conclusions:
We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO.
Insights
Multidrug-resistant organisms (MDROs) are increasingly prevalent in postoperative peritonitis (POP), impacting antibiotic effectiveness. Carbapenem and vancomycin combinations are crucial for adequate empirical antibiotic therapy (EAT) in these cases.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Temporal shifts in antimicrobial resistance are documented for severe infections.
- Postoperative peritonitis (POP) lacks data on resistance trends and their clinical impact.
- Assessing multidrug-resistant organisms (MDROs) in POP is crucial for treatment efficacy.
Purpose of the Study:
- To evaluate the prevalence and temporal trends of MDROs in POP over two decades.
- To analyze the impact of MDROs on the adequacy of empirical antibiotic therapy (EAT) in POP.
- To identify optimal antibiotic regimens for POP, considering MDRO prevalence.
Main Methods:
- Retrospective monocentric analysis of ICU adult patients with POP (1999-2019).
- Evaluation of microbiological data, MDRO emergence, and EAT adequacy.
- In vitro assessment of 10 antibiotics against 17 regimens for optimal EAT selection.
Main Results:
- 45% of 422 patients harbored MDROs, with increasing MDR Enterobacterales over time.
- EAT adequacy was 73% overall, significantly lower in patients with MDROs (p<0.0001).
- Piperacillin/tazobactam-based regimens showed decreased adequacy; carbapenem/vancomycin combinations were most effective against MDROs.
Conclusions:
- High MDRO proportions in POP are associated with rising MDR Enterobacterales.
- Adequate EAT for POP with MDROs requires carbapenem and vancomycin combinations.
- Piperacillin/tazobactam is no longer a preferred EAT for POP involving MDROs.
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