sultamicillin and Intraabdominal-Infections

The ideal antimicrobial treatment for intra-abdominal infections (IAIs) in the setting of fast-paced emergency departments (EDs) should be effective, convenient, and of limited resource utilization. Antibiotic monotherapy is a feasible option for this. We conducted a study in which we compared two regimens for antibiotic monotherapy recommended by published guidelines in ED patients with community-acquired, complicated IAIs (cIAIs).. The study was a prospective, randomized, study of ampicillin-sulbactam versus moxifloxacin for cIAIs. After the diagnosis of cIAI was established, patients were assigned randomly to receive either moxifloxacin 400 mg intravenously (IV) qd followed by moxifloxacin 400 mg orally (PO) qd, or ampicillin-sulbactam 1.5 g IV qid followed by ampicillin-sulbactam 750 mg PO q12h. Source control procedures were used for all patients and all had complete follow-up. The primary efficacy variable for the study was the clinical response at the test-of-cure visit.. A total of 116 patients were enrolled for prospective evaluation and randomized assignment to treatment with ampicillin-sulbactam (n=55) or moxifloxacin (n=61). At the test-of-cure evaluation, the overall clinical failure rate was 13.8%. The clinical failure rates in the ampicillin-sulbactam and moxifloxacin groups were 16.4% (9/55) and 11.5% (7/61), respectively (p=0.446). With regard to infection site, the clinical failure rate in cIAIs consisting of lower gastrointestinal (GI) tract infection was significantly lower in the moxifloxacin than in the ampicillin-sulbactam group (4.3% vs. 19.6%; p=0.024). According to multivariable analysis, independent risk factors for treatment failure were the time to ED presentation >24 h (odds ratio [OR] 6.8; 95% CI 1.3-36.2; p=0.024) and ampicillin-sulbactam therapy (OR 9.5; 95% CI 1.1-76.6; p=0.033).. A significant difference existed in the clinical responses of the two groups. As compared with ampicillin-sulbactam, moxifloxacin was more effective for the treatment of community-acquired cIAIs of the lower GI tract. A higher risk of treatment failure for antibiotic therapy was found for patients presenting to the ED with symptoms of cIAIs lasting >24 h. Alternative antimicrobial agents should be considered for treating these patients.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Analysis of Variance; Anti-Bacterial Agents; Aza Compounds; Community-Acquired Infections; Female; Fluoroquinolones; Humans; Intraabdominal Infections; Logistic Models; Male; Middle Aged; Moxifloxacin; Prospective Studies; Quinolines; Risk Factors; Sulbactam; Taiwan; Treatment Outcome; Young Adult

In this study, we aimed to investigate the results of intraoperative culture and antibiogram in children who underwent surgery with the diagnosis of community-acquired intraabdominal infections (CA-IAIs) to determine the causative microorganisms and antibiotic susceptibility of the bacterial agents.. Antibiotic susceptibility of isolated bacteria was investigated with disk diffusion method according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) suggestions directly from the patients' intraabdominal peritoneal fluid or tissues, aged <18 years.. Bacterial growth was found in 17 (34%) of the blood cultures taken before the operation and 38 (76%) of the intraoperative abdominal cultures. According to the isolated strains; 44 (80%) were Gram-negative and 11 (20%) were Gram-positive, however, the most commonly isolated microorganisms were Escherichia coli (52.72%), Klebsiella pneumonia (14.54%), and Enterobacter cloacae (5.45%); extended-spectrum beta-lactamase (ESBL) resistance was detected in 12 of the Escherichia coli strains (41.38%) and the rates of ampicillin-sulbactam, ceftriaxone, and cefotaxime resistance were 43.2%, 40.9%, and 6.8%, respectively.. In our study, ESBL-resistant gram-negative microorganisms in CA-IAIs presented as primary agents to be considered. Ampicillin-sulbactam, ceftriaxone and cefotaxime should not be preferred in the monotherapy of complicated CA-IAIs due to their high resistance rates, but they can be combined with aminoglycosides. Quinolones can be included in the treatment because of their low resistance rates. It is considered that routine intraoperative culture and evaluation of antibiotic susceptibility in complicated CA-IAIs will provide an insight into the outcomes of empirical treatment.. Antimicrobial resistance, Intraabdominal infection, Surgery.. In questo studio abbiamo analizzato i risultati delle colture intraoperatorie con antibiogramma in bambini operati con diagnosi di infezione intraaddominale acquisita da comunità (CA-IAIs) per determinare gli agenti microbici responsabili e la relativa sensibilità ad antibiotici.. Sono stati inclusi nello studio pazienti di età <18 anni, presentati all’ambulatorio di chirurgia pediatrica nel periodo compreso tra marzo 2017 e marzo 2018, e sottoposti ad intervento chirurgico con la diagnosi di CB-IAI. Sangue prelevato preoperatoriamente e da 1 a 10 ml di liquido peritoneale sono stati inoculati su piastre di agar sangue e agar EMB. Le sensibilità agli antibiotici dei microrganismi isolati sono state valutate in conformità alle raccomandazioni EUCAST (European Committee on Antimicrobial Susceptibility Testing)con il metodo della diffusione dei dischi.. Dei 50 pazienti sottoposti all’operazione, 31 (62%) erano ragazzi e 19 (38%) ragazze. L’età media era di 10,96±4,67 anni. Lo sviluppo batterico è stato rilevato in 17 (34%) delle colture di sangue e in 38 (76%) delle colture addominali intraoperatorie. Dei ceppi isolati, 44 (80%) erano Gram-negativi e 11 (20%) erano Gram-positivi. I microrganismi più frequentemente isolati erano E.coli 52,72%, K.pneumonia 14,54%, Enterobatteri 5,45%. La resistenza alla beta-lattamasi a spettro esteso (ESBL) è stata rilevata in 12 (41,38%) dei ceppi di E.coli. Il tasso di resistenza all’ampicillina-sulbactam era del 43,2%, il tasso di resistenza al ceftriaxone e al cefotaxime era del 40,9%, mentre il tasso di resistenza alla ciprofloxacina era del 6,8%.. Nel nostro studio, i microrganismi gramnegativi resistenti alle GSBL nella CB-IAI sono i fattori che dovrebbero essere considerati per primi. Nel trattamento delle CB-IAI complicate, ampicillina-sulbactam e ceftriaxone e cefotaxime non dovrebbero essere preferiti in monoterapia a causa dei loro alti tassi di resistenza, ma possono essere associati con aminoglicosidi. I chinoloni possono essere inclusi nel trattamento perché i loro tassi di resistenza sono bassi. Come si può vedere, la coltura intraoperatoria di routine e la valutazione della suscettibilità antibiotica nelle CB-IAI complicate rappresentano informazioni utili per l’adozione di un trattamento empirico.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Community-Acquired Infections; Escherichia coli; Humans; Intraabdominal Infections; Microbial Sensitivity Tests

To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (<20%). Although most ESBL-positive hospital-acquired isolates were resistant to third- and fourth-generation cephalosporins, the majority were susceptible to cefoxitin (47.9% to 83.9%). Susceptibilities of ESBL-positive isolates to ampicillin-sulbactam (<10%) were low, whereas susceptibilities to ciprofloxacin (0% to 54.6%) and levofloxacin (0% to 63.6%) varied substantially. The prevalences of cephalosporin-susceptible E. coli and K. pneumoniae were higher in the northeastern and southern regions than in the central and eastern regions, reflecting the ESBL-positive rates in these areas, and were lowest in the Jiangsu-Zhejiang (Jiang-Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Cefoxitin; China; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Ertapenem; Gene Expression; Humans; Imipenem; Intraabdominal Infections; Levofloxacin; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sulbactam