Assessing national guidelines for secondary intra-abdominal infection empiric antimicrobial therapy: review of the bacteriology and antimicrobial susceptibility in a spanish tertiary-level hospital.


Background and Goal of Study:
Extended-spectrum β-lactamase-producing Enterobacteriaceae in community-acquired and carbapenem-resistant Enterococcus faecium in health care-associated intraabdominal infection are the main future problems we could face in a near future due to its increasing incidence in our environment. National guidelines for secondary intra-abdominal infection recommend the use of Cefotaxim + metronidazole or β-lactamase inhibitor combination for community-acquired and carbapenem for health careassociated intra-abdominal infection. 
The goal of the study is to asses the suitability of the empiric antimicrobial therapy recommended by national guidelines for secondary intra-abdominal infection in our institution.
 Materials and Methods.
A retrospective clinical review was conducted in our institution during (2015). We reviewed bacteriology of patients with secondary peritonitis and positive intraoperative culture. We reviewed antimicrobial susceptibility to the main agents used for empiric community-acquired and health care-associated intra-abdominal infection.
Results and Discussion.
130 patients with secondary intra-abdominal infection and positive intraoperative culture were indentified (83 community-acquired and 47 health care-associated). Enterobacteriaceae species remain the major pathogens in community-acquired infections; 13% of these patients were not susceptible to β-lactam or β-lactamase inhibitor combination.
Enterobactericeae species also remain the major pathogens in health care -associated infection but Enterococcus species are isolated in 60% of the cases. 25% of these patients were not susceptible to carbapenem because of ampicilin-resistant Enterococcus species. 

Conclusion(s). 
Community-acquired patients are tolerably covered with the current empiric treatment but high incidence of carbapenem-resistant Enterococcus species demmands the use of linezolid, daptomycin or vancomycin. 
References.
1. Guirao X, Arias J, Badia JM, García-Rodríguez JA, Mensa J, Álvarez-Lerma F, Borges M, Barberán J, Maseda E, Salavert M, Llinares P, Gobernado M, García Rey C. Recommendations in the empiric anti-infective agents of intra-abdominal infection. Rev Esp Quimioter. 2009 Sept;22 (3):151-72. 
2. Jones RN. Prediction of enterococcal imipenm susceptibility using ampicilin or penicilin MICs: more evidence for a class concept. J Clin Microbiol. 2001 Oct; 39(10):3810-

Assessing national guidelines for secondary intra-abdominal infection empiric antimicrobial therapy: review of the bacteriology and antimicrobial susceptibility in a spanish tertiary-level hospital