Key result
Obesity was not associated with an increased risk of a composite of all complications compared to non-obese patients treated for intra-abdominal infection (25.3% vs. 19.8%, p=0.14).
Why the study?
Is obesity associated with antimicrobial treatment failure in patients with intra-abdominal infection?
Cohort (n=518)
Is obesity associated with antimicrobial treatment failure in patients with intra-abdominal infection?
Absolute Event Rate: 25.3% vs 19.8%
p-value: p=0.14
Obesity does not appear to independently increase the risk of antimicrobial treatment failure in patients with intra-abdominal infections, suggesting prolonged therapy may not be necessary based solely on BMI.
Obesity may raise recurrent IAI risk; leaves open whether BMI should guide antimicrobial dosing.
BACKGROUND: Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. METHODS: Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. RESULTS: Overall, 198 (38.3%) of patients were obese (BMI ≥30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). CONCLUSIONS: Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.
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Dietch et al. (2016) conducted a cohort in Intra-abdominal infection (n=518). Obesity (BMI ≥30) vs. Non-obese was evaluated on Composite of all complications (p=0.14). Obesity was not associated with an increased risk of a composite of all complications compared to non-obese patients treated for intra-abdominal infection (25.3% vs. 19.8%, p=0.14).
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