title: Clinical characteristics and antimicrobial patterns in complicated intra-abdominal infections: a 6-year epidemiological study in southern China.
abstract: Complicated intra-abdominal infection (cIAIs) are a common and important cause of morbidity worldwide. In this study, the clinical features, microbiological profiles, antimicrobial patterns and treatments of 3233 cIAI patients (mean age, 47.6 years; 54.7% male) with 3531 hospitalisations from 2008-2013 were retrospectively investigated. The most commonly isolated bacteria were Escherichia coli (47.6%), Klebsiella pneumoniae (16.9%), Enterococcus faecalis (10.4%) and Pseudomonas aeruginosa (8.8%). Ciprofloxacin, aminoglycoside (gentamicin), piperacillin/tazobactam and carbapenems exhibited activity against 53%, 76%, 88% and 100% of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae isolates, respectively. Pseudomonas aeruginosa isolates exhibited 100%, 95%, 88%, 71% and 76% susceptibility to aminoglycoside (gentamicin), ciprofloxacin, meropenem, imipenem and ceftazidime, respectively, and Enterococcus remained 100% susceptible to vancomycin and linezolid. β-Lactam antibacterials other than penicillin (specifically third-generation cephalosporins) and imidazole derivatives (ornidazole and metronidazole) were the most common first-line treatments. Patients subjected to regimen change after initial antibiotic treatment had predisposing conditions (e.g. older age, more severe co-morbidities) and a higher incidence of P. aeruginosa infection; in addition, these patients encountered a higher average cost of care and worse clinical outcomes compared with those without medication modification. Taken together, these findings indicate the importance of appropriate initial empirical therapy and suggest the use of combination therapy comprising cephalosporins and metronidazole.
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou 510120, China.
authors.forename: Wenwei
authors.initials: W
authors.lastname: Ouyang
authors.affiliation: R & D Information China, AstraZeneca, 199 Liangjing Road, Pudong, Shanghai 201203, China; College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, Liaoning Province 110866, China.
authors.forename: Huiling
authors.initials: H
authors.lastname: Xue
authors.affiliation: R & D Information China, AstraZeneca, 199 Liangjing Road, Pudong, Shanghai 201203, China.
authors.forename: Yunqin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: R & D Information China, AstraZeneca, 199 Liangjing Road, Pudong, Shanghai 201203, China.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Gao
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou 510120, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Li
authors.affiliation: R & D Information China, AstraZeneca, 199 Liangjing Road, Pudong, Shanghai 201203, China. Electronic address: jenny.wei@astrazeneca.com.
authors.forename: Jia
authors.initials: J
authors.lastname: Wei
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou 510120, China. Electronic address: wenzh@gzucm.edu.cn.
authors.forename: Zehuai
authors.initials: Z
authors.lastname: Wen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D013293:Enterococcus faecalis / Q000187:drug effects; D016021:Epidemiologic Studies; D004926:Escherichia coli / Q000187:drug effects; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D000078142:Tazobactam; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D005839:Gentamicins; D002939:Ciprofloxacin; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin
keywords: Antibiotic resistance; Complicated intra-abdominal infection; Cost of care; ESBL-positive Enterobacteriaceae; Empirical antibiotic therapy; Pseudomonas aeruginosa