Antimicrobial susceptibility of common pathogens isolated from postoperative intra-abdominal infections in Japan |
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| Authors: | Yoshio Takesue Shinya Kusachi Hiroshige Mikamo Junko Sato Akira Watanabe Hiroshi Kiyota Satoshi Iwata Mitsuo Kaku Hideaki Hanaki Yoshinobu Sumiyama Yuko Kitagawa Kazuhiko Nakajima Takashi Ueda Motoi Uchino Toru Mizuguchi Yoshiyasu Ambo Masafumi Konosu Keiichiro Ishibashi Katsunori Yanagihara |
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| Affiliation: | 1. The Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan;2. Kitasato University Institute, Tokyo, Japan;3. Japan Society for Surgical Infection, Tokyo, Japan;4. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan;5. Department of Surgery, Teine Keijinkai Hospital, Hokkaido, Japan;6. Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan;g. Department of Digestive Tract and General Surgery Saitama Medical Center, Saitama Medical University, Saitama, Japan;h. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan;i. Department of Surgery, National Defense Medical College, Saitama, Japan;j. Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan;k. Department of Surgery, Keio University School of Medicine, Tokyo, Japan;l. Department of Surgery, Toho University Medical Center Ohashi, Tokyo, Japan;m. Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan;n. Department of Surgery, Kouseiren Takaoka Hospital, Toyama, Japan;o. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan;p. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan;q. Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan;r. Departments of Innovative Surgery, Mie University Graduate School of Medicine, Mie, Japan;s. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan;t. Osaka Medical College, Department of General and Gastroenterological Surgery, Osaka, Japan;u. Department of Surgery, Osaka Rosai Hospital, Osaka, Japan;v. Department of Surgery, Sakai City Medical Center, Osaka, Japan;w. Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan;x. Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan;y. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan;z. Department of Surgery, Mazda Hospital, Hiroshima, Japan;11. Yamaguchi University, Yamaguchi, Japan;12. Division of Surgical Oncology, Tottori University Faculty of Medicine, Tottori, Japan;13. Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan;14. Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Fukuoka, Japan;15. Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan |
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| Abstract: | The principle of empirical therapy for patients with intra-abdominal infections (IAI) should include antibiotics with activity against Enterobacteriaceae and Bacteroides fragilis group species. Coverage of Pseudomonas aeruginosa, Enterobacter cloacae, and Enterococcus faecalis is also recommended for hospital-associated IAI. A nationwide survey was conducted to investigate the antimicrobial susceptibility of pathogens isolated from postoperative IAI. All 504 isolates were collected at 26 institutions and referred to a central laboratory for susceptibility testing. Lower susceptibility rates to ciprofloxacin and cefepime were demonstrated in Escherichia coli. Among E. coli, 24.1% of strains produced extended-spectrum β-lactamase (ESBL). Carbapenems, piperacillin/tazobactam, cephamycins/oxacephem, aminoglycosides, and tigecycline had high activity against E. coli, including ESBL-producing isolates. Among E. cloacae, low susceptibility rates to ceftazidime were demonstrated, whereas cefepime retained its activity. P. aeruginosa revealed high susceptibility rates to all antimicrobials tested except for imipenem. Among B. fragilis group species, low levels of susceptibility were observed for cefoxitin, moxifloxacin, and clindamycin, and high susceptibility rates were observed for piperacillin/tazobactam, meropenem, and metronidazole. Ampicillin, piperacillin, and glycopeptides had good activity against E. faecalis. Imipenem had the highest activity against E. faecalis among carbapenems. In conclusion, we suggested the empirical use of antimicrobials with the specific intent of covering the main organisms isolated from postoperative IAI. Piperacillin/tazobactam, meropenem, or doripenem, are appropriate in critically ill patients. Combination therapy of cefepime (aztreonam in patients with β-lactam allergy) plus metronidazole plus glycopeptides, imipenem/cilastatin or cephamycins/oxacephem plus ciprofloxacin plus metronidazole are potential therapeutic options. |
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| Keywords: | Postoperative infection Intra-abdominal infection Surveillance Antibiotic susceptibility Extended-spectrum β-lactamase Corresponding author. Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. |
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