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Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection
J A Hopkins1, J C Lee, S E Wilson
1University of California, Irvine, Dept. of Surgery, Orange 92668.
Abstract:
Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections. One hundred thirty-six (78%) patients were males. The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5. Overall recovery without infection was 75 per cent (131/175). Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection. Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates. Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures. Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent. A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.
Insights
Antimicrobial resistance in operative site bacteria is linked to postoperative infections in intra-abdominal sepsis patients. Identifying resistant organisms like E. coli can predict and help manage infection risks.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Microbiology
Background:
- Intra-abdominal sepsis presents a significant challenge, with postoperative infection being a major complication.
- Operative site flora and its antimicrobial resistance patterns are crucial factors influencing patient outcomes.
Purpose of the Study:
- To investigate the correlation between antimicrobial resistance of operative site flora and the incidence of postoperative infections in patients with intra-abdominal sepsis.
- To identify specific resistant organisms and other predictive factors for postoperative infectious complications.
Main Methods:
- A cohort of 175 patients undergoing surgery for intra-abdominal sepsis was studied.
- Intraoperative isolates (939) were analyzed for antimicrobial susceptibility.
- Statistical analysis, including stepwise logistic regression, was used to determine predictive factors for infection.
Main Results:
- A significant relationship (P = 0.0002) was found between resistance to empiric antimicrobials and postoperative infection.
- Patients with postoperative infectious complications had a higher prevalence of resistant isolates (82%) compared to those with resolved infections (44%).
- Key resistant organisms included Streptococcus Group D, Escherichia coli, and Bacteroides fragilis. Age and admission white blood cell count also predicted outcomes.
Conclusions:
- Antimicrobial resistance of intraoperative isolates is a significant predictor of postoperative infection in intra-abdominal sepsis.
- Empiric antimicrobial selection should consider local resistance patterns.
- Age and admission white blood cell count are additional factors influencing infectious complications.