Additionally, in high-risk patients attention should be given to the antibiograms of the particular institution, with initial antibiotic choice tailored to the risk of methicillin or vancomycin resistant organisms, and extended spectrum beta lactamase producers. Compared to patients initially treated with broad-spectrum antibiotics, patients who receive inadequate empiric treatment have longer hospital stays, higher
rates of postoperative abscesses and re-operation, and increased mortality[90, 91]. Furthermore, changing regimens in response to cultures that display resistance does not GS-4997 purchase improve outcomes. Therefore, the use of broader-spectrum agents from the outset appears crucial to optimizing outcomes in high-risk patients. While cultures do not alter outcomes in high risk patients, it is recommended that cultures be obtained in this group in order to de-escalate antibiotic
therapy to avoid increasing resistance. Infections that Require Special Consideration MRSA Though an uncommon cause of IAI, MRSA deserves special consideration. Treatment often includes vancomycin, which has a low bactericidal selleck chemicals activity and achievable tissue concentrations of the drug may not meet the minimum inhibitory concentration (MIC). As a result, these infections may require longer courses of antimicrobial therapy. Continuous infusion of vancomycin may be a solution to this problem. In addition, newer antibacterials such as linezolid, tigecycline, ertapenem, and moxifloxacin are
also promising, and have demonstrated non-inferiority in several studies of IAI[40, 92–95]. learn more Enterococcus The use of antibiotic therapy for Enterococcus in IAI is controversial. Enterococcus can often be isolated from IAI, and is associated with increased risk of treatment failure and higher mortality[96, 97]. However, outcomes in these patients have shown to be independent of antibiotic coverage for enterococcus[97, 98]. Currently, the general consensus regarding enterococcal coverage is that community-acquired infections require no coverage, however ampicillin, or vancomycin should be Fludarabine solubility dmso added to cover the following high risk patient groups: 1) patients in septic shock who have received prolonged treatment with cephalosporins or other antibiotics that select for Enterococcus, 2) immunocompromised patients, 3) patients with prosthetic heart valves, or other intravascular prosthetic devices, or 4) patients with health care associated/recurrent intra-abdominal infection[40, 99]. Finally, vancomycin resistant enterococcal (VRE) infections occur in patients who are immunocompromised, previously colonized with VRE or treated with vancomycin. In these circumstances VRE should be suspected and treated with alternatives such as linezolid, tigecycline, or daptomycin. In the absence of these risk factors, specific coverage for VRE is not recommended.