Objective:

To assess the association between inappropriate initial empiric antibiotic therapy and the clinical outcome among patients undergoing surgery for community-acquired intra-abdominal infections (IAI) in Israel.

Methods:

Records of patients who underwent surgery for community-acquired IAI from January 2000 to June 2002 in hospitals in Israel were reviewed. Initial empiric antibiotic therapy was classified as inappropriate if at least one pathogen was resistant to all antibiotics in initial regimen in case of positive culture or not according to guidelines in case of negative/missing culture. Therapy was classified as successful if IAI was resolved with initial therapy or with decrease from initial therapy; as unsuccessful otherwise. Logistic regression analyses were performed to assess associations between inappropriate therapy and clinical outcome, after adjusting for patients’ characteristics and site/type of infection.

Results:

279 patients were included. Mean (SD) age was 53.2 years (21.05) while 36.8% were female. Almost 87% of the patients received appropriate initial empiric therapy, while 75.9% of all patients’ initial empiric therapy was successful. Compared with patients on appropriate therapy, patients on inappropriate therapy were less likely to have IAI resolved with initial therapy (45.9 vs. 80.2%, P < 0.0001). Multivariate logistic regression showed that patient who received inappropriate initial empiric therapy were almost four times less likely to have success in their therapy (OR = 3.6, 95%CI: 1.6–7.8).

Conclusion:

Among patients undergoing surgery for community-acquired IAI in Israel, inappropriate initial empiric antibiotic therapy significantly increases the likelihood of unsuccessful clinical outcomes.