Impact an anatomical site on bacteriological and clinical outcome in the management of intra-abdominal infections.
The clinical and bacteriological results of treatment for 429 patients who had intra-abdominal infection were analyzed to determine whether the anatomical origin of peritonitis influenced outcome. All patients had received effective broad spectrum antimicrobial therapy and operation in four multicenter trials. The diagnoses of infection were categorized into three sites: upper gastrointestinal tract, complicated appendicitis, and lower gastrointestinal tract. Clinical response rates were excellent for complicated appendicitis and were lowest for infections related to the upper gastrointestinal tract. Bacteriological response rates were also lower for upper gastrointestinal tract organisms and were highest for isolates associated with complicated appendicitis. There were no deaths in the 213 patients who had infection associated with appendicitis. Seven deaths occurred in the 86 patients (81%) with an upper gastrointestinal site of infection, and nine deaths occurred in the 130 patients (6.5%) with lower gastrointestinal site of infection. Mortality was related to recurrent intra-abdominal infection after an unsuccessful primary operation and a serum albumin less than 25 g/l. Clinical trails of antimicrobials for intra-abdominal infection should consider stratification of patients according to these three levels of alimentary tract perforation when the site is known preoperatively. Patients who have infection secondary to previous surgery or who are malnourished represent a higher risk group even with appropriate antibiotics.
Wilson
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SE
Department of Surgery, University of California, Irvine, USA.
Faulkner
K
K
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001431:Bacteriological Techniques; D002423:Cause of Death; D015377:Cilastatin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D013845:Thienamycins / Q000627:therapeutic use; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015377:Cilastatin; D002981:Clindamycin; D015378:Imipenem; D000077731:Meropenem; D014031:Tobramycin