Microbiology And Best Empiric Antimicrobial Therapy In Organ/Space Surgical Site Infection After Elective Colorectal Surgery
Morressier, 2017
Online
unknown
Background and goal of study: Organ/space surgical site infections (osSSI) as anastomotic leak and intraabdominal abscess are an important cause of morbility after elective colorectal surgery.A prompt empiric antimicrobial therapy must be started in order to improve the recovery.A continuous knowledge of local flora is important to establish an adequate therapeutic strategy. An empiric antibiotic treatment which covers more than 90% of pathogens is recommended.The goal of the study is to determine the microbiology of organ/space SSI after elective colorectal surgery and to assess the best empiric antimicrobial therapy. Materials and methods: We retrospectively analyzed the incidence of osSSI after elective colorectal surgery in a terciary hospital (January 2014/December 2016). Most important variables analyzed were: type of pathogens isolated (Gram-negative bacilli, extended-spectrum u03b2-lactamases-producing Enterobacteriaceae, Ps.aeruginosa, Gram-positive coccus, E.faecium ampicillin resistant, methicillin-resistant S. aureus and fungi) and suitability of the most common empiric antimicrobial therapies used in these patients: -tAmoxycillin/clavulanic acid (AC)-tPiperacillin/Tazobactam (PTZ)-tImipenem (I)-tMeropenem + Linezolid (ML)-tMeropenem + Linezolid + Fluconazole (MLF)Results and discussion: 49 patients with osSSI were analyzed. 39 patients had positive cultures. All cultures were polymicrobial.Pathogens isolated were: 74% Gram-negative bacilli, 54% Gram-positive coccus, 46%E. faecium ampiciline resistant, 23% fungi, 13% Ps.aeruginosa, 10% extended-spectrum u03b2-lactamases-producing Enterobacteriaceae and 5% methicillin-resistant S. aureus.Adequate treatment would be achieved in 92% of patients with MLF combination, 80.5% with ML, 33% with I or PTZ and just 23% with AC. Conclusion: The most common pathogens isolated in osSSI after colorectal surgery were Gram-negative bacilli and Gram-positive coccus. These results are consistent with previous studies.The high prevalence of E.faecium ampicillin resistant and fungi found in our population, makes empiric treatment with ILF the most adequate. Based in our results, a change in our previous empiric antimicrobial therapy should be considered.
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Microbiology And Best Empiric Antimicrobial Therapy In Organ/Space Surgical Site Infection After Elective Colorectal Surgery
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Veröffentlichung: | Morressier, 2017 |
Medientyp: | unknown |
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