Introduction: Postoperative complications for cholecystitis and cholelithiasis are important causes of intra-abdominal infections (IAIs). There have been no previous reports on intra-abdominal bacteriology in complicated IAIs due to acute cholecystitis (AC). Material and methods: The data came from two prospective multicenter observational cohort studies (CIAO: the "Complicated Intra-Abdominal infection Observational" study and CIAOW: the "Complicated Intra-Abdominal infection Observational World" study) which involved 116 medical institutions worldwide with consecutive patients who underwent surgery, interventional drainage or conservative treatment for AC. Results: Of 567 patients, there were 291 males (51.3%). The mean and median age were 62.5 and 64 years respectively. 546 (96.3%) had community-acquired and 21 (3.7%) patients had health-care-associated infections. 267 bacteria were isolated, 21 (7.8%) were resistant bacteria. No resistant Fungi or Anaerobes were isolated. 4 out of the 21 resistant bacteria were health-care-associated. Multivariate analysis demonstrated health-care associated infection (p = 0.03), inadequacy of empiric antimicrobial therapy (p = 0.003) and recent antimicrobial therapy (p < 0.0001) to be factors associated with resistant bacteria. The factors associated with mortality were presence of generalized peritonitis (p < 0.0001) and inadequate source control (p = 0.018). The factors associated with ICU admission were severe sepsis (p < 0.0001), generalized peritonitis (p = 0.001), concomitant malignancy (p = 0.037), inadequate source control (p = 0.025), delay in initial intervention (p < 0.0001) and age over 70 years (p = 0.025). Conclusion: The number of infection caused by Extended Spectrum Beta-Lactamase bacteria (ESBL+) and Klebsiella pneumoniae Carbapenemase-producer bacteria (KPC+) were common in acute cholecystitis and in community-acquired infections. An adequate empirical antimicrobial therapy was fundamental to reduce bacterial resistance and to improve outcomes.

Coccolini, F., Sartelli, M., Catena, F., Montori, G., Di Saverio, S., Sugrue, M., et al. (2015). Antibiotic resistance pattern and clinical outcomes in acute cholecystitis: 567 consecutive worldwide patients in a prospective cohort study. INTERNATIONAL JOURNAL OF SURGERY, 21, 32-37 [10.1016/j.ijsu.2015.07.013].

Antibiotic resistance pattern and clinical outcomes in acute cholecystitis: 567 consecutive worldwide patients in a prospective cohort study

Marco Ceresoli;Luca Ansaloni
2015

Abstract

Introduction: Postoperative complications for cholecystitis and cholelithiasis are important causes of intra-abdominal infections (IAIs). There have been no previous reports on intra-abdominal bacteriology in complicated IAIs due to acute cholecystitis (AC). Material and methods: The data came from two prospective multicenter observational cohort studies (CIAO: the "Complicated Intra-Abdominal infection Observational" study and CIAOW: the "Complicated Intra-Abdominal infection Observational World" study) which involved 116 medical institutions worldwide with consecutive patients who underwent surgery, interventional drainage or conservative treatment for AC. Results: Of 567 patients, there were 291 males (51.3%). The mean and median age were 62.5 and 64 years respectively. 546 (96.3%) had community-acquired and 21 (3.7%) patients had health-care-associated infections. 267 bacteria were isolated, 21 (7.8%) were resistant bacteria. No resistant Fungi or Anaerobes were isolated. 4 out of the 21 resistant bacteria were health-care-associated. Multivariate analysis demonstrated health-care associated infection (p = 0.03), inadequacy of empiric antimicrobial therapy (p = 0.003) and recent antimicrobial therapy (p < 0.0001) to be factors associated with resistant bacteria. The factors associated with mortality were presence of generalized peritonitis (p < 0.0001) and inadequate source control (p = 0.018). The factors associated with ICU admission were severe sepsis (p < 0.0001), generalized peritonitis (p = 0.001), concomitant malignancy (p = 0.037), inadequate source control (p = 0.025), delay in initial intervention (p < 0.0001) and age over 70 years (p = 0.025). Conclusion: The number of infection caused by Extended Spectrum Beta-Lactamase bacteria (ESBL+) and Klebsiella pneumoniae Carbapenemase-producer bacteria (KPC+) were common in acute cholecystitis and in community-acquired infections. An adequate empirical antimicrobial therapy was fundamental to reduce bacterial resistance and to improve outcomes.
Si
Articolo in rivista - Articolo scientifico
Scientifica
Acute cholecystitis; Antibiotic; Antimicrobial; Bacteriology; Infection; Peritonitis; Spectrum; Therapy;
English
32
37
6
Coccolini, F., Sartelli, M., Catena, F., Montori, G., Di Saverio, S., Sugrue, M., et al. (2015). Antibiotic resistance pattern and clinical outcomes in acute cholecystitis: 567 consecutive worldwide patients in a prospective cohort study. INTERNATIONAL JOURNAL OF SURGERY, 21, 32-37 [10.1016/j.ijsu.2015.07.013].
Coccolini, F; Sartelli, M; Catena, F; Montori, G; Di Saverio, S; Sugrue, M; Ceresoli, M; Manfredi, R; Ansaloni, L
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/381260
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