Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections.
OBJECTIVE
The objective of this study is to describe the frequency of inappropriate empirical antibiotic therapy in secondary intra-abdominal infection and to identify the possible relationship between inappropriateness and some clinical outcomes.


METHODS
A retrospective descriptive multicenter study was conducted using hospital secondary databases developed at two university hospitals located in northeast Spain. Participants were patients 18 years of age or older who were diagnosed with community-acquired intra-abdominal infections between January 1, 1998, and December 31, 2000, identified through computerized patient records using ICD-9 codes. Appropriateness of empirical treatment was defined according to the recommendations of the literature. The clinical outcome of each patient was classified as one of the following: (i) resolved with initial therapy, (ii) required second-line antibiotics, (iii) required re-operation, or (iv) in-hospital death. The Fisher's exact test or the Chi-squared test for categorical variables and the t-test or Mann-Whitney test for continuous variables were used for comparing groups. Conditional logistic and linear regression analyses were also applied.


RESULTS
Of 376 cases, 51 cases (13.6 percent, 95 percent confidence interval, 10-17 percent) received inappropriate empirical antibiotic therapy according to the scientific literature. Inappropriate initial empirical treatment was significantly associated with the need for a second line of antibiotics (p < .001), although not with re-operation, mortality, or length of hospitalization.


CONCLUSIONS
Approximately 14 percent of the patients received inappropriate empirical antibiotic treatment. Worse clinical outcomes consistently were observed in the group of patients receiving inappropriate empirical treatment. The appropriateness of antibiotic treatment for a given infection, in light of the availability of clearly defined clinical guidelines is an easily evaluated aspect of the quality of care.
Breast Cancer Screening Office/Epidemiology Department, UDIAT-CD, Corporació Sanitària Parc Taulí, Institut Universitari-Universitat Autònoma de Barcelona, Parc Taulí s/n, Sabadell, Spain. mbare@cspt.es
Marisa
M
Baré
Xavier
X
Castells
Angel
A
Garcia
Marta
M
Riu
Mercè
M
Comas
Maria José Gil
MJ
Egea
D000005:Abdomen; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000601:surgery; D017714:Community-Acquired Infections / Q000188:drug therapy*; D017723:Drug Utilization Review; D006302:Health Services Research; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents