title: Intra-abdominal Infections: The Role of Anaerobes, Enterococci, Fungi, and Multidrug-Resistant Organisms.
abstract: BACKGROUND
  Intra-abdominal infections (IAI) constitute a common reason for hospitalization. However, there is lack of standardization in empiric management of (1) anaerobes, (2) enterococci, (3) fungi, and (4) multidrug-resistant organisms (MDRO). The recommendation is to institute empiric coverage for some of these organisms in "high-risk community-acquired" or in "healthcare-associated" infections (HCAI), but exact definitions are not provided.
  
  
  METHODS
  Epidemiological study of IAI was conducted at Assaf Harofeh Medical Center (May-November 2013). Logistic and Cox regressions were used to analyze predictors and outcomes of IAI, respectively. The performances of established HCAI definitions to predict MDRO-IAI upon admission were calculated by receiver operating characteristic (ROC) curve analyses.
  
  
  RESULTS
  After reviewing 8219 discharge notes, 253 consecutive patients were enrolled (43 [17%] children). There were 116 patients with appendicitis, 93 biliary infections, and 17 with diverticulitis. Cultures were obtained from 88 patients (35%), and 44 of them (50%) yielded a microbiologically confirmed IAI: 9% fungal, 11% enterococcal, 25% anaerobic, and 34% MDRO. Eighty percent of MDRO-IAIs were present upon admission, but the area under the ROC curve of predicting MDRO-IAI upon admission by the commonly used HCAI definitions were low (0.73 and 0.69). Independent predictors for MDRO-IAI were advanced age and active malignancy.
  
  
  CONCLUSIONS
  Multidrug-resistant organism-IAIs are common, and empiric broad-spectrum coverage is important among elderly patients with active malignancy, even if the infection onset was outside the hospital setting, regardless of current HCAI definitions. Outcomes analyses suggest that empiric regimens should routinely contain antianaerobes (except for biliary IAI); however, empiric antienterococcal or antifungals regimens are seldom needed.
authors.affiliation: Department of Cardiology.
authors.forename: Gil
authors.initials: G
authors.lastname: Marcus
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Samuel
authors.initials: S
authors.lastname: Levy
authors.affiliation: Department of Emergency Medicine.
authors.forename: Ghaleb
authors.initials: G
authors.lastname: Salhab
authors.affiliation: Department of Internal Medicine A , and.
authors.forename: Bethlehem
authors.initials: B
authors.lastname: Mengesha
authors.affiliation: Department of Cardiology.
authors.forename: Oran
authors.initials: O
authors.lastname: Tzuman
authors.affiliation: Department of Internal Medicine A , and.
authors.forename: Shira
authors.initials: S
authors.lastname: Shur
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Erica
authors.initials: E
authors.lastname: Burke
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Rebecca Cruz
authors.initials: RC
authors.lastname: Mayeda
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Lior
authors.initials: L
authors.lastname: Cochavi
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Idan
authors.initials: I
authors.lastname: Perluk
authors.affiliation: Department of Internal Medicine A , and.
authors.forename: Ronit
authors.initials: R
authors.lastname: Zaidenstein
authors.affiliation: Clinical Microbiology Laboratory, Assaf Harofeh Medical Center , Zerifin , Israel.
authors.forename: Tsilia
authors.initials: T
authors.lastname: Lazarovitch
authors.affiliation: Unit of Infectious Diseases.
authors.forename: Mor
authors.initials: M
authors.lastname: Dadon
authors.affiliation: Unit of Infectious Diseases,; Sackler School of Medicine, Tel-Aviv University, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
keywords: MDRO; biliary infection; epidemiology; nosocomial infections; surgical infection.