Surgical Site Infections: Does Inadequate Antibiotic Therapy Affect Patient Outcomes?
Surgical Site Infections: Does Inadequate Antibiotic Therapy Affect Patient Outcomes?
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DOI：
10.1089/sur.2008.053
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发表时间：
2009-08-01
影响因子：
2
通讯作者：
Nicolau, David P.
中科院分区：
文献类型：
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作者：
Eagye, Kathryn J.;Kim, Aryun;Nicolau, David P.
背景：复杂的皮肤/皮肤结构感染涉及更深的软组织，包括手术部位感染（SSI）。抗生素治疗 (TAT) 不足与呼吸道和血流感染的不良后果相关，但很少在 SSI 中进行评估。本研究评估了 TAT 对复杂 SSI 中住院时间 (LOS) 和费用等主要结果的影响；确定与接受 TAT 相关的危险因素是次要目标。方法：这项回顾性队列研究对 2004 年第 4 季度至 2006 年第 1 季度从我们拥有 810 个床位的城市教学医院出院的患者进行了回顾性队列研究，在 298 名术后感染患者中确定了 130 名复杂性 SSI 患者。排除浅表感染和不涉及皮肤/皮肤结构的感染。从图表中收集患者特征、培养数据和抗生素使用史。据说，当培养 24 小时内没有给予针对培养的微生物的活性药物时，就会出现抗生素治疗不足的情况。多元回归确定了与 LOS 相关的变量并增加了医院会计成本。 结果：共有 39 名受试者 (30%) 接受了 IAT；患者特征与接受充分治疗的患者没有差异，除了 IAT 受试者更可能先前使用过抗生素 (p = 0.053)。金黄色葡萄球菌（45% 耐甲氧西林）是最常见的病原体 (39%)。超过一半 (60%) 的受试者接受了经验性万古霉素治疗。 TAT 患者感染后 LOS 较长，费用较高（中位数 [25%, 75%]）：10 [6, 21] 天 vs. 7 [4, 11] 天； （p = 0.007 和 11,746 美元 [6,652 美元，28,442 美元] 对比 7,116 美元 [5,210 美元，16,443 美元]；p = 0.04）。较长的 LOS 与急性生理学和慢性健康评估评分、TAT、假单胞菌感染和胸骨切口显着相关，成本较高（假单胞菌感染除外）。在多种微生物感染（p < 0.001）、假单胞菌感染（p < 0.001）或肠球菌感染（p = 0.002）以及腹部切口感染（p < 0.001）中，抗生素治疗不充分的可能性更大。耐甲氧西林金黄色葡萄球菌与不良后果无关，可能是因为经验性治疗经常包括万古霉素。结论：抗生素治疗不足与复杂 SSI 中更长的 LOS 和更高的费用相关。 IAT 的危险因素包括既往抗生素治疗、多种微生物感染、铜绿假单胞菌或肠球菌感染以及腹部切口。
Background: Complicated skin/skin structure infections involve deeper soft tissues and include surgical site infections (SSIs). Inadequate antibiotic therapy (TAT) has been associated with adverse outcomes in respiratory and blood stream infections, but is seldom evaluated in SSIs. This study assessed the impact of TAT on primary outcomes of length of stay (LOS) and costs in complicated SSIs; identifying risk factors associated with receiving TAT was a secondary objective.Methods: This retrospective cohort study of discharges from our 810-bed urban teaching hospital from Quarter 4/2004 Quarter 1/2006 identified 130 patients with complicated SSI among 298 patients with postoperative infections. Superficial infections and infections not involving the skin/skin structures were excluded. Patient characteristics, culture data, and antibiotic history were collected from charts. Inadequate antibiotic therapy was said to have occurred when a drug active against the organism cultured was not given within 24h of culture. Multiple regression identified variables associated with LOS and increase hospital accounting costs.Results: A total of 39 subjects (30%) received IAT; patient characteristics did not differ from those receiving adequate therapy, except that prior antibiotic use was more likely in IAT subjects (p = 0.053). Staphylococcus aureus (45% methicillin-resistant) was the most common pathogen (39%). More than one-half (60%) of the subjects received empiric vancomycin. The TAT patients experienced longer post-infection LOS and higher costs (median [25%, 75%]): 10 [6, 21] days vs. 7 [4, 11] days; (p = 0.007 and $11,746 [$6,652, $28,442] vs. $7,116 [$5,210, $16,443]; p = 0.04). Longer LOS was associated significantly with Acute Physiology and Chronic Health Evaluation score, TAT, Pseudomonas infection, and sternal incisions, as were higher costs, excepting Pseudomonas infection. Inadequate antibiotic therapy was more likely in polymicrobial infections (p < 0.001), pseudomonal (p < 0.001) or enterococcal (p = 0.002) infections, and infected abdominal incisions (p < 0.001). Methicillin-resistant S. aureus was not associated with adverse outcomes, possibly because empiric therapy frequently included vancomycin.Conclusions: Inadequate antibiotic therapy is associated with longer LOS and higher costs in complicated SSIs. Risk factors for IAT include prior antibiotic therapy, polymicrobial infection, infection with P. aeruginosa or Enterococcus spp., and abdominal incisions.