THE EFFECT OF EMPIRICAL VS CULTURE-BASED THERAPY ON PATIENT OUTCOMES WITH COMPLICATED INTRA-ABDOMINAL INFECTION AT KHYBER TEACHING HOSPITAL PESHAWAR
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Keywords
Intra-abdominal infections, Empirical therapy, Culture-based therapy, Efficacy
Abstract
Intra-abdominal infections are peritoneal inflammation in response to microorganisms, resulting in pus formation in the peritoneal cavity. Intra-abdominal infections are of two types: uncomplicated and complicated based on the severity of the infection. To compare the efficacy of empirical and culture-based therapy in a patient with complicated intra-abdominal infections presenting to Khyber Teaching Hospital Peshawar, a total of 694 patients of both genders with complicated intra-abdominal infections were included in the study. A sample size of 347 patients was calculated for the culture-based therapy group or Group A while 347 sample size for the empirical therapy group or Group B. Efficacy was noted after the 14th day for both groups. The age range in this study was 15 to 65 years with a mean age of 31.204±10.96 years, a mean duration of disease 55.659±18.27 hours, and a mean weight of 71.400±11.72 Kg in Group A. The mean age of the patients in Group B was 29.953±9.79 years, the mean duration of disease was 56.005 ± 18.19 hours and the mean weight was 70.308±10.81 Kg in Group B. Efficacy was observed in 310 (89.3%) patients in group A as compared to 296 (85.3%) patients in group B (P= 0.110). Our study showed that Moxifloxacin monotherapy was as well tolerated and effective as culture-based therapy in the treatment of patients with complicated intra-abdominal infections
References
2. Stefanidis, D., et al., The role of diagnostic laparoscopy for acute abdominal conditions: an evidence-based review. Surgical endoscopy, 2009. 23(1): p. 16-23.
3. Warren, O., et al., Emergency laparoscopy–current best practice. World Journal of Emergency Surgery, 2006. 1(1): p. 1-9.
4. Koperna, T., D. Semmler, and F. Marian, Risk stratification in emergency surgical patients: is the APACHE II score a reliable marker of physiological impairment? Archives of surgery, 2001. 136(1): p. 55-59.
5. Billing, A., D. Fröhlich, and P.S. Group, Prediction of outcome using the Mannheim peritonitis index in 2003 patients. British journal of surgery, 1994. 81(2): p. 209-213.
6. Panhofer, P., et al., Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis. Langenbeck's archives of surgery, 2009. 394(2): p. 265-271.
7. Lang, E., et al., Abdominal abscess drainage under radiologic guidance: causes of failure. Radiology, 1986. 159(2): p. 329-336.
8. Deakin, D. and I. Ahmed, Interval appendicectomy after resolution of adult inflammatory appendix mass—is it necessary? The surgeon, 2007. 5(1): p. 45-50.
9. Mazuski, J.E., et al., The surgical infection society revised guidelines on the management of intra-abdominal infection. Surgical infections, 2017. 18(1): p. 1-76.
10. Inui, T., et al., Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection. Surgery, 2009. 146(4): p. 654-662.
11. Emmi, V. and G. Sganga, Diagnosis of intra-abdominal infections: clinical findings and imaging. Le Infezioni in Medicina, 2008. 16: p. 19-30.
12. Physicians, A.C.o.C. and S.o.C.C.M.C.C. Committee, American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med, 1992. 20: p. 864-874.
13. Puylaert, J., F.M. van der Zant, and A.M. Rijke, Sonography and the acute abdomen: practical considerations. AJR. American journal of roentgenology, 1997. 168(1): p. 179-186.
14. Haddad, N., et al., The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance. BMC Infectious Diseases, 2019. 19(1): p. 1-20.
15. Sartelli, M., et al., Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World Journal of Emergency Surgery, 2014. 9(1): p. 1-10.
16. Pisake Boontham, M. and R. Soontornrak, Intra-abdominal infections: prevalence and risk factors of ESBLs infections. J Med Assoc Thai, 2015. 98(11): p. 1097-103.
17. Zhang, S., et al., Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study. BMC infectious diseases, 2016. 16(1): p. 1-18.
18. Avkan-Oğuz, V., et al., Recommendations for intra-abdominal infections consensus report. Turkish Journal of Surgery/Ulusal Cerrahi Dergisi, 2016. 32(4): p. 306.
19. Solomkin, J.S., et al., Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surgical infections, 2010. 11(1): p. 79-109.
20. Brandt, D., et al., Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Diseases of the colon & rectum, 2006. 49(10): p. 1533-1538.
21. Chandra, V., et al., Impact of primary resection on the outcome of patients with perforated diverticulitis. Archives of surgery, 2004. 139(11): p. 1221-1224.
22. Malangoni, M.A., et al., Randomized controlled trial of moxifloxacin compared with piperacillin–tazobactam and amoxicillin–clavulanate for the treatment of complicated intra-abdominal infections. Annals of surgery, 2006. 244(2): p. 204.
23. Salmanov, A.G., A.V. Kolesnik, and D.V. Andriuschenko, EPIDEMIOLOGY OF INTRA-ABDOMINAL INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY. Wiadomości Lekarskie, 2019. 72(4): p. 513-518.
24. Sartelli, M., et al., The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 2017. 12(1): p. 1-34.
25. Solomkin, J.S., et al., Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Annals of surgery, 1996. 223(3): p. 303.
26. Montravers, P., et al., Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clinical Infectious Diseases, 1996. 23(3): p. 486-494.
27. Majewski, W., Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial. Surgical Endoscopy And Other Interventional Techniques, 2005. 19(1): p. 81-90.
28. vanSonnenberg, E., et al., Percutaneous drainage of abscesses and fluid collections: technique, results, and applications. Radiology, 1982. 142(1): p. 1-10.
29. Bufalari, A., G. Giustozzi, and L. Moggi, Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta chirurgica Belgica, 1996. 96(5): p. 197-200.
30. Pappas, P.G., et al., Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 2009. 48(5): p. 503.
31. Merlino, J.I., et al., Prospective randomized trials affect the outcomes of intraabdominal infection. Annals of surgery, 2001. 233(6): p. 859.
32. Golan, Y., et al., Emergence of fluoroquinolone resistance among Bacteroides species. Journal of Antimicrobial Chemotherapy, 2003. 52(2): p. 208-213.
33. Cohn, S.M., et al., Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections. Annals of surgery, 2000. 232(2): p. 254.
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Rubina Yaseen
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
Qaviullah Mian
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
Asad Farooq
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
Ajmal Khan
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
Muhammad Naeem
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
Mushtaq Ahmad
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan