TY - JOUR
T1 - Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections
AU - Baré, Marisa
AU - Castells, Xavier
AU - Garcia, Angel
AU - Riu, Marta
AU - Comas, Mercè
AU - Egea, Maria José Gil
PY - 2006/4/20
Y1 - 2006/4/20
N2 - 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. Copyright © 2006 Cambridge University Press.
AB - 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. Copyright © 2006 Cambridge University Press.
KW - Appropriateness
KW - Empirical therapy
KW - Intra-abdominal infection
KW - Mortality
KW - Outcomes assessment
KW - Quality of care
U2 - 10.1017/S0266462306051063
DO - 10.1017/S0266462306051063
M3 - Article
VL - 22
SP - 242
EP - 248
JO - International Journal of Technology Assessment in Health Care
JF - International Journal of Technology Assessment in Health Care
SN - 0266-4623
IS - 2
ER -