Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

Yong Pil Chong,In-Gyu Bae,Jin-Won Chung,Eun Ju Choo,Eun Jung Lee,Yang Soo Kim,Mi Suk Lee,Jae-Bum Jun,Seong Yeon Park,Min Hyok Jeon,Soo-Youn Moon,Sang-Rok Lee,Eun Hee Song,Jörn-Hendrik Weitkamp

doi:10.1371/journal.pone.0119956

Abstract

ObjectivesComplicated 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.MethodsA 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.ResultsA 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.ConclusionsTo 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.

Highlights

Failure of initial antibiotic therapy was associated with increased costs and morbidity
Complicated intra-abdominal infection is an infection that extends beyond the hollow viscus of origin into the peritoneal space, causing peritonitis or abscess formation
Using multiple linear regression analysis, we found that health care-associated infection, steroid use, neurologic disease or malignancy as a comorbid condition, generalized peritonitis, ICU care, and Acute Physiology and Chronic Heath Evaluation (APACHE) II score 13 were significantly related to the number of parenteral antibiotic days

Summary

Introduction

Complicated intra-abdominal infection (cIAI) is an infection that extends beyond the hollow viscus of origin into the peritoneal space, causing peritonitis or abscess formation. These infections typically require both surgical or percutaneous intervention and intravenous antimicrobial therapy, and are associated with substantial morbidity and mortality. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAIs [5,6,7,8] In these studies, the impact of health care-associated infection was not assessed. The main objectives of this study were to determine the frequency of failure of initial antibiotic therapy for community-onset cIAIs (including health care-associated cIAIs) and to determine the associated impact on medical costs and clinical outcomes.

Objectives

Results

Conclusion