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Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections

Published online by Cambridge University Press:  28 March 2006

Marisa Baré ,
Xavier Castells ,
Angel Garcia ,
Marta Riu ,
Mercè Comas  and
Maria José Gil Egea
Marisa Baré
Affiliation:
UDIAT-CD, Corporació Sanitària Parc Taulí
Xavier Castells
Affiliation:
Universitat Autònoma de Barcelona and Institut Municipal d'Assistència Sanitària
Angel Garcia
Affiliation:
Corporació Sanitària Parc Taulí
Marta Riu
Affiliation:
Institut Municipal d'Assistència Sanitària
Mercè Comas
Affiliation:
Institut Municipal d'Assistència Sanitària
Maria José Gil Egea
Affiliation:
Institut Municipal d'Assistència Sanitària
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Abstract

Objectives: The objective of this study is to describe the frequency of inappropriate empirical antibiotic therapy in secondary intra-abdominal infection and to identify the possible relationship between inappropriateness and some clinical outcomes.

Methods: A retrospective descriptive multicenter study was conducted using hospital secondary databases developed at two university hospitals located in northeast Spain. Participants were patients 18 years of age or older who were diagnosed with community-acquired intra-abdominal infections between January 1, 1998, and December 31, 2000, identified through computerized patient records using ICD-9 codes. Appropriateness of empirical treatment was defined according to the recommendations of the literature. The clinical outcome of each patient was classified as one of the following: (i) resolved with initial therapy, (ii) required second-line antibiotics, (iii) required re-operation, or (iv) in-hospital death. The Fisher's exact test or the Chi-squared test for categorical variables and the t-test or Mann–Whitney test for continuous variables were used for comparing groups. Conditional logistic and linear regression analyses were also applied.

Results: Of 376 cases, 51 cases (13.6 percent, 95 percent confidence interval, 10–17 percent) received inappropriate empirical antibiotic therapy according to the scientific literature. Inappropriate initial empirical treatment was significantly associated with the need for a second line of antibiotics (p<.001), although not with re-operation, mortality, or length of hospitalization.

Conclusions: Approximately 14 percent of the patients received inappropriate empirical antibiotic treatment. Worse clinical outcomes consistently were observed in the group of patients receiving inappropriate empirical treatment. The appropriateness of antibiotic treatment for a given infection, in light of the availability of clearly defined clinical guidelines is an easily evaluated aspect of the quality of care.

Keywords

AppropriatenessOutcomes assessmentEmpirical therapyMortalityIntra-abdominal infectionQuality of care
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 2 , April 2006 , pp. 242 - 248
Copyright
© 2006 Cambridge University Press

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