The quinolone class of antimicrobial agents is one of most widely used classes of antimicrobial agents in outpatient and inpatient treatment. However, quinolone resistance in gram-positive and gram-negative bacteria has emerged and increased globally. This resistance limits the usefulness of quinolones in clinical practice. The review summarizes mechanisms of quinolone resistance and its epidemiology and implications in the most common clinical settings, urinary tract infections, respiratory tract infections, intraabdominal infections, skin and skin structure infections, and sexually transmitted diseases.
Anti-Infective Agents ; Drug Resistance ; Epidemiology* ; Gram-Negative Bacteria ; Humans ; Inpatients ; Intraabdominal Infections ; Outpatients ; Quinolones ; Respiratory Tract Infections ; Sexually Transmitted Diseases ; Skin ; Urinary Tract Infections

PURPOSETo investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections (CIAIs) and hospital-acquired or nosocomial intraabdominal infections (NIAIs) in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAIs as well as NIAIs, and to provide a reference for clinical treatment.

METHODSWe collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software.

RESULTSA total of 221 patients were enrolled in the study, including 144 with CIAIs (55 mild-moderate and 89 severe) and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gram-negative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe CIAIs presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs (p < 0.05). There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAIs mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and gram-positive bacteria; and severe CIAIs were from either type of infection. The rate of Extended Spectrum b-Lactamase-producing Escherichia coli and Klebsiella pneumoniae was much higher in NIAIs than in CIAIs (p < 0.05). The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs.

CONCLUSIONCIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of antimicrobial drugs. Regional IAIs pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.

Adult ; Aged ; Bacterial Infections ; drug therapy ; epidemiology ; Community-Acquired Infections ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; drug therapy ; epidemiology ; microbiology ; Female ; Humans ; Intraabdominal Infections ; drug therapy ; epidemiology ; microbiology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prospective Studies

OBJECTIVETo investigate the risk factors of intra-abdominal infection(IAI) after colorectal cancer surgery.

METHODSClinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group (110 cases, IAI group) and non intra-abdominal infection group(663 cases, non-IAI group). All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI.

RESULTSPreoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists (ASA) anesthetic grading score (all P<0.05). Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging (all P<0.05). Multivariate logistic regression analysis showed that preoperative diabetes(OR=2.36, 95% CI:1.45 to 4.76, P<0.01), combined exenteration (OR=2.02, 95% CI:1.02 to 4.00, P<0.01), anastomotic leak (OR=4.41, 95% CI:1.77 to 10.99, P=0.001), operation time≥140 minutes (OR=2.88, 95% CI:1.78 to 4.67, P<0.01) and period of postoperative drainage≥10 days(OR=4.57, 95% CI:2.78 to 7.52, P<0.01) were independent risk factors of postoperative IAI, while the use of stapler was protective factor (OR=0.37, 95% CI: 0.23 to 0.60, P<0.01). Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI(OR=2.10, 95% CI:1.23 to 3.58, P=0.007).

CONCLUSIONSPrevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.

Anastomotic Leak ; Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; adverse effects ; Drainage ; Humans ; Intestinal Obstruction ; Intraabdominal Infections ; epidemiology ; Laparoscopy ; Neoplasm Staging ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Factors

OBJECTIVE: To investigate the distribution and antimicrobial susceptibility of causative microorganisms recovered from patients with intra-abdominal infections (IAIs). METHODS: A total of 2,926 bacterial and fungal strains were identified in samples collected from 1,679 patients with IAIs at the Peking Union Medical College Hospital between 2011 and 2021. Pathogenic bacteria and fungi were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing (AST) was performed using the VITEK 2 compact system and the Kirby-Bauer method. AST results were interpreted based on the M100-Ed31 clinical breakpoints of the Clinical and Laboratory Standards Institute. RESULTS: Of the 2,926 strains identified, 49.2%, 40.8%, and 9.5% were gram-negative bacteria, gram-positive bacteria, and fungi, respectively. Escherichia coli was the most prevalent pathogen in intensive care unit (ICU) and non-ICU patients; however, a significant decrease was observed in the isolation of E. coli between 2011 and 2021. Specifically, significant decreases were observed between 2011 and 2021 in the levels of extended-spectrum β-lactamase (ESBL)-producing E. coli (from 76.9% to 14.3%) and Klebsiella pneumoniae (from 45.8% to 4.8%). Polymicrobial infections, particularly those involving co-infection with gram-positive and gram-negative bacteria, were commonly observed in IAI patients. Moreover, Candida albicans was more commonly isolated from hospital-associated IAI samples, while Staphylococcus epidermidis had a higher ratio in community-associated IAIs. Additionally, AST results revealed that most antimicrobial agents performed better in non-ESBL-producers than in ESBL-producers, while the overall resistance rates (56.9%-76.8%) of Acinetobacter baumanmii were higher against all antimicrobial agents than those of other common gram-negative bacteria. Indeed, Enterococcus faecium, Enterococcus faecalis, S. epidermidis, and S. aureus were consistently found to be susceptible to vancomycin, teicoplanin, and linezolid. Similarly, C. albicans exhibited high susceptibility to all the tested antifungal drugs. CONCLUSION The distribution and antimicrobial susceptibility of the causative microorganisms from patients with IAIs were altered between 2011 and 2021. This finding is valuable for the implementation of evidence-based antimicrobial therapy and provides guidance for the control of hospital infections.
Humans ; Anti-Bacterial Agents ; Escherichia coli ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Retrospective Studies ; Staphylococcus aureus ; Intraabdominal Infections/epidemiology* ; Candida albicans ; Coinfection

BACKGROUND: We conducted this study to describe the epidemiology of community-acquired bacteremia and identify its prognostic factors. MATERIALS AND METHODS: All patients admitted to a community-based tertiary hospital with community-acquired bacteremia from June 2002 to May 2004 were included and analyzed retrospectively. RESULTS: During the study period, clinically significant community-acquired bacteremia occurred in 223 patients with the frequency of 5.3 patients per 1,000 patient-admission. The commonly isolated organisms were E. coli (47.1%), K. pneumoniae (13.0%), S. aureus (8.1%), and S. pneumoniae (4.5 %). The leading source of bacteremia were urinary tract infection (34.5%), intraabdominal infection (33.6%), primary bacteremia (10.3%), and skin & soft tissue infection (8.1%). The overall mortality was 17%. S. aureus (34.8%) and K. pneumoniae (30.4%) were two major organisms of primary bacteremia with high case fatality of 50% and 28.6%, respectively. Univariate analysis showed that the followings were associated with significant increase in mortality: male patient; S. aureus and other streptococci bacteremia; increasing APACHE II score; definite diagnosis after 3 days of admission; inappropriate antibiotics therapy within 24 hours of admission; emergency room; admission to ICU. The independent predictors of mortality were male patient (RR 3.02, P=0.031), increasing APACHE II score (RR 1.12, P=0.011), and admission to ICU (RR 9.73, P<0.001). CONCLUSION: Rapid definite diagnosis and prompt administration of appropriate antibiotics according to the local epidemiologic pattern are the most important controllable factors for the better outcome.
Anti-Bacterial Agents ; APACHE ; Bacteremia* ; Diagnosis ; Emergency Service, Hospital ; Epidemiology ; Humans ; Intraabdominal Infections ; Male ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Tertiary Care Centers* ; Urinary Tract Infections

BACKGROUND: We conducted this study to describe the epidemiology of community-acquired bacteremia and identify its prognostic factors. MATERIALS AND METHODS: All patients admitted to a community-based tertiary hospital with community-acquired bacteremia from June 2002 to May 2004 were included and analyzed retrospectively. RESULTS: During the study period, clinically significant community-acquired bacteremia occurred in 223 patients with the frequency of 5.3 patients per 1,000 patient-admission. The commonly isolated organisms were E. coli (47.1%), K. pneumoniae (13.0%), S. aureus (8.1%), and S. pneumoniae (4.5 %). The leading source of bacteremia were urinary tract infection (34.5%), intraabdominal infection (33.6%), primary bacteremia (10.3%), and skin & soft tissue infection (8.1%). The overall mortality was 17%. S. aureus (34.8%) and K. pneumoniae (30.4%) were two major organisms of primary bacteremia with high case fatality of 50% and 28.6%, respectively. Univariate analysis showed that the followings were associated with significant increase in mortality: male patient; S. aureus and other streptococci bacteremia; increasing APACHE II score; definite diagnosis after 3 days of admission; inappropriate antibiotics therapy within 24 hours of admission; emergency room; admission to ICU. The independent predictors of mortality were male patient (RR 3.02, P=0.031), increasing APACHE II score (RR 1.12, P=0.011), and admission to ICU (RR 9.73, P<0.001). CONCLUSION: Rapid definite diagnosis and prompt administration of appropriate antibiotics according to the local epidemiologic pattern are the most important controllable factors for the better outcome.
Anti-Bacterial Agents ; APACHE ; Bacteremia* ; Diagnosis ; Emergency Service, Hospital ; Epidemiology ; Humans ; Intraabdominal Infections ; Male ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Tertiary Care Centers* ; Urinary Tract Infections

intraabdominal infections (IAIs).METHODS: This multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems.RESULTS: A total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively.CONCLUSION: Enterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or Klebsiella spp. to amoxicillin/clavulanate, advanced-generation cephalosporins, and ciprofloxacin should be considered when determining empirical antibiotic therapy in clinical practice.]]>
Acinetobacter ; Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Cross Infection ; Enterococcus ; Epidemiology ; Escherichia coli ; Humans ; Imipenem ; Intraabdominal Infections ; Klebsiella ; Korea ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pseudomonas aeruginosa ; Retrospective Studies ; Vancomycin

OBJECTIVETo compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.

METHODSClinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.

RESULTSA total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].

CONCLUSIONSMorbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak ; epidemiology ; etiology ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrovascular Disorders ; epidemiology ; etiology ; Chylous Ascites ; epidemiology ; etiology ; Comorbidity ; Comparative Effectiveness Research ; Duodenal Diseases ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Gastroscopy ; Hemoperitoneum ; epidemiology ; etiology ; Humans ; Intestinal Fistula ; epidemiology ; etiology ; Intraabdominal Infections ; epidemiology ; etiology ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Postoperative Hemorrhage ; epidemiology ; etiology ; Postoperative Period ; Respiratory Tract Infections ; epidemiology ; etiology ; Retrospective Studies ; Risk Assessment ; Robotic Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery ; Surgical Wound Infection ; epidemiology ; etiology

OBJECTIVETo investigate the predictive value of procalcitonin(PCT) in postoperative intra-abdominal infections (IAI) after definitive operation of intestinal fistulae(IF).

METHODSWith the exclusion of emergence operation, preoperative clinical infection, preoperative renal or hepatic dysfunction, and age less than 18 years, a total of 356 consecutive patients who underwent elective digestive tract reconstruction of intestinal fistulae from February 2012 to December 2015 at Intestinal Fistula Center of Jinling Hospital were prospectively enrolled in the study. All the patients were divided into IAI group (26 cases, 21 of anastomosis leakage and 5 of peritoneal abscess) and non-IAI group (330 cases) based on the existence of postoperative IAI. The non-IAI group was then divided into two subgroups of other infection (93 cases) and non-infection(237 cases) according to the presence of other infections. Plasma PCT level, serum CRP concentration and WBC count were assessed preoperatively and on postoperative days (PODs) 1, 3, 5, 7 by immunofluorescence, turbidimetry and automatic blood analyzer, respectively. The predictive value of each marker for IAI was calculated by receiver operating characteristic (ROC) curve.

RESULTSThere was no significant difference in general clinical data between IAI and non-IAI group (all P>0.05). The proportions of multi-IF (53.8%, 14/26) and colectomy (61.5%, 16/26) in IAI group were higher than those of non-IAI group [20.0% (66/330), χ=15.847, P=0.000 and 31.2%(103/330), χ=9.961, P=0.002]. Differences of preoperative PCT, CRP and WBC levels among IAI, other infection and non-infection groups were not significant. These three markers all increased obviously and immediately after surgery. PCT and WBC values reached the peak point on POD 1, whereas CRP on POD 3. In IAI group, mean PCT values were (5.4±4.2) μg/L, (2.9±1.9) μg/L and (1.6±1.8) μg/L on POD 1, POD 3 and POD 5, respectively, which were higher than those of other infection group [(4.2±8.7) μg/L, (1.9±3.8) μg/L and (0.6±0.8) μg/L] and non-infection group [(2.7±5.8) μg/L, (1.1±1.7) μg/L and (0.5±0.7) μg/L, all P<0.05]. Mean CRP values in IAI group were 99.4 mg/L and 183.9 mg/L respectively on POD 1 and POD 3,and mean WBC values of IAI group on POD 1, POD 3 and POD 5 were 16.0×10/L, 10.8×10/L and 8.7×10/L, respectively, which were all significantly higher than those in the other 2 groups (all P<0.05). No significant differences were obtained between other infection group and non-infection group in all these three markers (all P>0.05). ROC curve demonstrated that PCT had the biggest area under the curve (AUC) of 0.86 and 0.84 on POD 3 and POD 5, with the cut-off value of 0.98 μg/L and 0.83 μg/L, 92.0% sensitivity and 74.0% specificity, 91.0% sensitivity and 73.0% specificity, respectively. The highest AUC was 0.72 on POD 3 for CRP and 0.71 on POD 3 for WBC, with 80.0% sensitivity and 54.0% specificity, 56.0% sensitivity and 73.0% specificity, respectively.

CONCLUSIONThe value of procalcitonin above 0.98 μg/L on POD 3 and 0.83 μg/L on POD 5 can predict the occurrence of IAI after definitive operations of intestinal fistulae.

Abdominal Abscess ; etiology ; Anastomotic Leak ; etiology ; Area Under Curve ; Biomarkers ; blood ; Calcitonin ; blood ; Colectomy ; adverse effects ; statistics & numerical data ; Elective Surgical Procedures ; adverse effects ; statistics & numerical data ; Female ; Humans ; Intestinal Fistula ; complications ; surgery ; Intraabdominal Infections ; etiology ; Male ; Postoperative Complications ; epidemiology ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity