Abstract
BackgroundThe purpose of this study was to determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients over eight years in China.MethodsWe retrospectively reviewed the microbial records of intra-abdominal specimens at a teaching hospital from 2008 to 2015. Study period was divided into the first half (2008–2011) and the second half (2012–2015). All isolates underwent antibiotic susceptibility testing by the micro dilution method.ResultsA total of 874 intra-abdominal isolates were consecutively collected from 502 GI fistula patients (mean age, 46.5 years, 71.1% male) during the study period. Patients in the second study period (2012–2015) were older (>65 years) and more likely to have experienced cancer. Over the entire study period, most infections were caused by E. coli (24.2%) and K. pneumonia (14.1%). There was a significant decrease in the proportion E. coli isolates that were extended- spectrum beta-lactamase (ESBL)-positive (P = 0.026). The proportion of E. coli resistant to imipenem increased from 14.3% in 2008–2011 to 25.9% in 2012–2015 (P = 0.037). Imipenem resistance prevalence was higher in ESBL-negative bacteria than ESBL-positive bacteria for both E. coli and K. pneumonia (P < 0.001). In Enterococcus, significant increase in resistance to ampicillin (P = 0.01) and moxifloxacin (P = 0.02) over time were observed. In Staphylococcus and fungi, rates of antibiotic resistance did not significantly change over the study period.ConclusionsGram-negative bacteria predominated as causative agents of intra-abdominal infections in GI fistula patients, and there was an increase in levels of resistance to certain antibiotics, particularly carbapenems. Infection control and source control are important tools available to surgeons to prevent the emergence of antibiotic-resistant pathogens.
Highlights
The purpose of this study was to determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients over eight years in China
Co-infection with multiple microbial strains was identified in 118(49.4%) patients during the first study period and 124(47.2%) during the second period
We found an increase in intra-abdominal infections (IAIs) attributable to K. pneumonia and A. baumannii infection over time, this increase did not reach statistical significance
Summary
The purpose of this study was to determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients over eight years in China. Gastrointestinal (GI) fistula is a complex and challenging problem associated with intra-abdominal infections (IAIs), leading to high morbidity and mortality worldwide [1, 2]. Effective treatment for IAIs patients involves both source control and antimicrobial therapy [3]. Selection and prompt initiation of the appropriate empiric antimicrobial therapy play an important role in decreasing morbidity and mortality in GI fistula patients with IAIs [5]. The Infectious Diseases Society of America (IDSA) guidelines recommend use of single agents, such as carbapenems, piperacillin/tazobactam, cephalosporins, fluoroquinolones and aminoglycosides combined with metronidazole to treat IAIs in adults [2]. The distribution of pathogens causing IAIs and their drug susceptibility
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