BACKGROUND AND GOAL OF THE STUDY
Appropiate and early empiric antibiotic therapy for complicated intra­-abdominal infection is essential for patient prognosis. Community-­acquired intra-­abdominal infection (CA-­IAI) usually envolves sensitive pathogens but incidence of multi­drug resistant bacteria is increasing. The goal of the study is to assess suitability of empiric antibiotherapy for CA-­IAI in our institution.  

MATERIAL AND METHODS
A retrospective clinical review was conducted in our institution from Jan 2016 to Sept 2017. We included patients with CA-­IAI and positive intraoperative cultures. We review bacteriology and susceptibility to the main agents used for CA-­IAI. Common regimes as empiric antibiotherapy for CA-­IAI in our institution includes beta­lactam (3rd generation cephalosporin) + metronidazole or beta­-lactamase inhibitor combination (amoxicillin­clavulanic acid or piperacillin-­tazobactam). We, carefully, consider extended-­sprectrum beta-­lactamase-­producing Enterobacteriaceae, ampicilin-resistant Enterococcus spp, Ps. aeruginosa, and Candida spp. as the main pathogens resistant to empiric coverage in our institution.

RESULTS AND DISCUSSION
137 patients with CA-­IAI and positive intraoperative culture were identified. Gram negative bacteria (GNB) remain the major pathogens in CA-­IAI (80%), gram positive bacteria are involved in 48% CA-­IAI cases, anaerobes 18% and fungii 7%. Extended­-spectrum beta­lactamase-producing Enterobacteriaceae was involved in 15% of CA-­IAI, ampicilin-­resistant Enterococcus spp 4%, Ps. aeruginosa 9% and Candida spp 7%. 
 
CONCLUSIONS
Extended-­spectrum beta-­lactamase Enterobacteriaceae increasing incidence in community-­acquired intra-abdominal infections represents a major problem for the future. In severe complicated intra-­abdominal infection with non optimum surgical source control carbapenem should be considered for empiric antibiotherapy despite community-­acquired origen. 


05 / Assesing empiric antibiotherapy in complicated community-acquired intraabdominal infection.