Is Ceftriaxone and Metronidazole Combination Effective in the Empirical Therapy of Intra-Abdominal Infections?/Intra-Abdominal Infeksiyonlarin Ampirik Tedavisinde Seftriakson ve Metronidazol Kombinasyonu Etkin mi?

• Published in: KLIMIK dergisi Vol. 37; no. 2; p. 131
• Main Authors: Derici, Zekai Serhan, Irmak, Caglar, Avkan-Oguz, Vildan
• Format: Journal Article
• Language: English
• Published: DOC Design and Informatics Co. Ltd 01.06.2024
• Subjects: Abdomen; Abscess; Analysis; Antibiotics; Care and treatment; Ceftriaxone; Ceftriaxone sodium; Health aspects; Infection; Metronidazole; Mortality
• ISSN: 1301-143X; 1309-1484
• DOI: 10.36519/kd.2024.4863

Objective: Ceftriaxone and metronidazole (CEF/MET) combination therapy is commonly used in the empirical therapy of intra-abdominal infections (IAIs). We aimed to evaluate the treatment response in patients started on empirical CEF/MET therapy and contribute current treatment data on IAIs. Methods: A retrospective analysis was conducted on patients receiving parenteral antibiotic therapy in the general surgery department between 2016 and 2018. Patients aged 18 and older who received CEF/MET therapy for more than 24 hours with a diagnosis of IAI were included. Patient characteristics, antibiotic use and/or surgical history in the last three months, infection source, need for surgical intervention, and clinical and laboratory data were evaluated. Treatment response was analyzed in groups of patients with or without treatment changes. Results: 10,649 patients were evaluated; 591 (5.5%) received CEF/MET therapy, and 297 (50.2%) met the study criteria. Among them, 243 (81.8%) received only CEF/MET treatment (Group 1), while 54 (18.2%) received additional antibiotics (median day 5) (Group 2). Of the patients, 31.6% (94/297) didn't have an underlying disease, history of antibiotic use, or surgical intervention in the last three months. Only 7.4% underwent treatment modification. A statistically significant relationship was found between data and treatment modification (p=0.001). The gallbladder (63%) or the biliopancreatic tract (12.1%) were the infection foci in 75.1% of all patients. Treatment was modified in 9.6% of the patients with an infection focus in the gallbladder and 55.6% of the patients with an infection focus in the biliopancreatic tract, with a statistically significant difference (p=0.001). Patients with treatment modification had more extended hospital stays and higher mortality rates (p=0.001). Conclusion: Obtaining information on possible infection sources and patient characteristics in the medical history will contribute to selecting the appropriate antibiotic for empirical treatment and improve treatment success. Empirical therapies that do not require treatment changes will result in shorter hospital stays and reduced mortality. Keywords: ceftriaxone, metronidazole, intra-abdominal infections, empirical treatment Amac: Seftriakson ve metronidazol kombinasyonu (SEF/MET), intra-abdominal infeksiyon (IAI)'larin ampirik tedavisinde yaygin olarak kullanilmaktadir. Calismanin amaci, ampirik SEF/MET tedavisi baslanan hastalarda tedavi yanitini degerlendirmek ve guncel tedavi verilerine katki saglamaktir. Yontemler: 2016-2018 arasini kapsayan uc yillik donemde, genel cerrahi servisinde parenteral antibiyotik tedavisi alan hastalar geriye donuk olarak incelendi. Calismaya IAI tanisiyla 24 saatten daha uzun sure SEF/MET tedavisi alan 18 yas ve uzeri hastalar dahil edildi. Hasta ozellikleri, son uc ayda antibiyotik kullanimi ve/veya cerrahi girisim oykusu, infeksiyon kaynagi, cerrahi girisim gereksinimi, klinik ve laboratuvar verileri degerlendirildi. Tedavi degisikligi yapilan ve yapilmayan hasta gruplarinda tedavi yaniti analiz edildi. Bulgular: Toplam 10 649 hasta degerlendirilmis olup 591 (%5.5) hasta SEF/MET tedavisi almisti. Bu hastalarin 297 (%50.2)'si calisma kriterlerini karsilamaktaydi. Hastalarin 243 (%81.8)'unun sadece SEF/MET tedavisi (Grup 1), 54 (%18.2)'unun ise ek antibiyotik tedavisi aldigi (ortanca 5. gun) saptandi (Grup 2). Hastalarin %31.6 (94/297)'sinin malignite dahil herhangi bir hastaligi, son uc ayda antibiyotik kullanimi, cerrahi girisim oykusu yoktu. Sadece %7.4'unde tedavi degisikligi yapilmisti. Veriler ile tedavi degisikligi arasinda anlamli duzeyde bir iliski saptandi (p=0.001). Tum hastalarin %75.1'inde infeksiyon odagi safra kesesi (%63) ve biliopankreatik traktustaydi (%12.1). Tedavi degisikligi, IAI odagi safra kesesi olanlarin %9.6'sinda, biliopankreatik traktus olanlarin %55.6'sinda yapildi. Intra-abdominal infeksiyonlarin odagi ile tedavi degisikligi arasinda anlamli duzeyde farklilik saptandi (p=0.001). Tedavi degisikligi yapilanlarda hastane yatis suresi daha uzun ve mortalite daha yuksekti (p=0.001). Sonuc: Anamnezde olasi infeksiyon kaynagi ve hasta ozelliklerinin ogrenilmesi, ampirik tedavide secilecek antibiyotigin belirlenmesine katki saglayacak ve tedavi basarisini artiracaktir. Bu sekilde; tedavi degisikligine ihtiyac duyulmayacak ampirik tedaviler ile hastanede yatis suresi kisalacak ve mortalite dusecektir. Anahtar sozcukler: seftriakson, metronidazol, intra-abdominal infeksiyon, ampirik tedavi