Key result
Guideline-concordant therapy for intra-abdominal infections linked to ~54% lower in-hospital mortality or 30-day readmission.
Why the study?
Treatment of intra-abdominal infections aligned with the 2017 revised Surgical Infection Society guidelines may improve patient outcomes, but comparisons of clinical outcomes between guideline concordant and discordant therapy were needed.
Does guideline concordant treatment reduce in-hospital mortality and 30-day re-admission in patients with intra-abdominal infections?
Observational (n=221)
Does guideline concordant treatment reduce in-hospital mortality and 30-day re-admission in patients with intra-abdominal infections?
Concordance with the 2017 revised Surgical Infection Society guidelines for intra-abdominal infections is associated with reduced in-hospital mortality and 30-day re-admission.
May support guideline adherence to reduce mortality/readmission; hypothesis-generating and requires randomized confirmation.
Background: Optimal treatment of intra-abdominal infections (IAIs) is multifaceted, typically requiring surgical intervention and antimicrobial therapy. Treatment of IAIs aligned with the 2017 revised Surgical Infection Society (SIS) guidelines may improve patient outcomes. Here we compare clinical outcomes of patients who received guideline concordant and discordant therapy for treatment of IAIs. Patients and Methods: This was a retrospective observational study of patients admitted from January 2013 to June 2016 with IAIs. Guideline concordant treatment was based on three criteria: source control, antibiotic choice, and antibiotic duration. The primary outcome was a composite of in-hospital mortality and 30-day re-admission. Multivariable logistic regression was used to determine independent factors associated with the composite end point. Results: A total of 221 patients were included, with guideline concordant treatment occurring in 117 (53%) patients. In-hospital mortality or 30-day re-admission occurred in 15 (12.8%) patients in the guideline concordant group compared with 24 (23.1%) in the guideline discordant group (p = 0.046). Empiric antibiotic choice was the most common component of discordance to guidelines (61% of patients). In multivariable analysis, guideline concordant treatment was associated with a decrease in the composite outcome (adjusted odds ratio [aOR] = 0.461, p = 0.045). In contrast, the presence of empiric methicillin-resistant Staphylococcus aureus (MRSA)/vancomycin-resistant Enterococcus (VRE) coverage (aOR: 2.645, p = 0.030), and moderate-to-severe liver disease (aOR: 8.081, p = 0.027) were associated with an increased risk for the composite outcome. Conclusions: Concordance to recommendations from the 2017 revised SIS guidelines is of critical importance in the optimal management of IAIs and further investigation of interventions to improve concordance are warranted.
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Nguyen et al. (2019) conducted an observational in Intra-abdominal infections (IAIs) (n=221). Guideline concordant treatment vs. Guideline discordant treatment was evaluated on Composite of in-hospital mortality and 30-day re-admission (aOR 0.461, p=0.045). Guideline concordant treatment for intra-abdominal infections was associated with a significantly lower risk of in-hospital mortality or 30-day re-admission (aOR 0.461, p=0.045).
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