tailieunhanh - Báo cáo y học: "Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis. | Augustin et al. Critical Care 2010 14 R20 http content 14 1 R20 c CRITICAL CARE RESEARCH Open Access Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis Pascal Augustin1 Nathalie Kermarrec1 Claudette Muller-Serieys2 Sigismond Lasocki1 Denis Chosidow3 Jean-Pierre Marmuse3 Nadia Valin4 Jean-Marie Desmonts1 Philippe Montravers1 Abstract Introduction The main objective was to determine risk factors for presence of multidrug resistant bacteria MDR in postoperative peritonitis PP and optimal empirical antibiotic therapy EA among options proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines. Methods One hundred patients hospitalised in the intensive care unit ICU for PP were reviewed. Clinical and microbiologic data EA and its adequacy were analysed. The in vitro activities of 9 antibiotics in relation to the cultured bacteria were assessed to propose the most adequate EA among 17 regimens in the largest number of cases. Results A total of 269 bacteria was cultured in 100 patients including 41 episodes with MDR. According to logistic regression analysis the use of broad-spectrum antibiotic between initial intervention and reoperation was the only significant risk factor for emergence of MDR bacteria odds ratio OR 95 confidence interval CI - 15 P . Antibiotics providing the best activity rate were imipenem cilastatin 68 and piperacillin tazobactam 53 . The best adequacy for EA was obtained by combinations of imipenem cilastatin or piperacillin tazobactam amikacin and a glycopeptide with values reaching 99 and 94 respectively. Imipenem cilastin was the only single-drug regimen providing an adequacy superior to 80 in the absence of broad spectrum antibiotic between initial surgery and reoperation. Conclusions Interval antibiotic therapy is associated with the presence of MDR bacteria. Not all regimens proposed by Infectious Disease .