Methods: All adult patients who were admitted between 1/2013-9/2015 to the surgical service with mild-to-moderate cIAI and received ≥ 48 hours of CFX or PTZ were evaluated retrospectively. Clinical failure defined as persistent clinical symptoms, escalation of therapy, continued microbial growth, and/or surgical intervention with ≥ 48 hours of empiric antibiotics was evaluated. Inappropriate empiric therapy based on cultures and susceptibilities, length of stay (LOS), recurrent infection, and 30 day mortality were also evaluated.
Results: One-hundred and sixty (160) patients were included with a median age of 42 years. Eighty (80) patients received CFX and 80 received PTZ with similar comorbidities. Appendicitis (49% vs. 31%, p=0.02) and cholecystitis (24% vs. 9%, p=0.01) occurred more in CFX group, while diverticulitis (14% vs. 29%, p=0.02) and intra-abdominal abscess (5% vs. 18%, p=0.02) occurred more in PTZ group. Clinical failure was 51% in CFX group and 36% in PTZ group, p=0.06. More patients in CFX group had persistent clinical symptoms (21% vs. 9%, p=0.03) or required escalation of therapy (19% vs 5%, p=0.01). Most common organism isolated was E. coli (n = 35), with only a few B. fragilis (n = 7). Only 1 B. fragilisisolate was resistant to CFX but CFX had higher rates of inappropriate empiric therapy (40% vs. 14%, p=0.06). LOS (3.8 days vs. 4.1 days, p=0.04), recurrent infection (16% vs. 8%, p=0.087) and 30 day mortality (0% vs 0%) were similar between both groups. Multivariate analysis showed cholecystitis as the only independent predictor of clinical failure (OR 4.4, 95% CI 1.7-11.2, p=0.002). The use of CFX or PTZ was not an independent predictor of clinical failure.
Conclusion: Clinical failure occurred more frequently with CFX vs. PTZ for treatment of mild-to-moderate cIAI, although more patients who received CFX had cholecysistitis, which was identified as an independent predictor of clinical failure.
M. R. Scipione, None
Y. Dubrovskaya, None
J. Papadopoulos, None