title: Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.
abstract: OBJECTIVE
  Complicated intra-abdominal infection (cIAI) is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.
  
  
  METHODS
  A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.
  
  
  RESULTS
  A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14%) had health care-associated infection, and 48 (9%) experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.
  
  
  CONCLUSIONS
  To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Chong
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, CheongJu St. Mary's Hospital, CheongJu, Republic of Korea.
authors.forename: Sang-Rok
authors.initials: SR
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: Jae-Bum
authors.initials: JB
authors.lastname: Jun
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Choo
authors.affiliation: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Soo-youn
authors.initials: SY
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Min Hyok
authors.initials: MH
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, GangNeung, Republic of Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Republic of Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents