Swenson et al identified factors associated with antibiotic resistance in pathogens causing intra-abdominal infections. These can help to identify a patient who may require more aggressive management. The authors are from the University of Virginia at Charlottesville.


Patient selection: intra-abdominal infection


Goal: identify a patient who may be resistant to standard antibiotic protocols using broad spectrum antibiotics


Organisms associated with antibiotic resistance:

(1) nonfermenting Gram negative bacteria

(2) enterococci and other Gram positive bacteria

(3) fungi


Risk factors for antibiotic resistance in organisms causing an intra-abdominal infection:

(1) association with a healthcare facility

(2) therapy with corticosteroids

(3) organ transplantation

(4) liver disease

(5) pulmonary disease

(6) duodenal source for the infection


Additional associations:

(1) liver transplantation: vancomycin-resistant enterococci

(2) healthcare exposures associated with higher risk: acquisition in the ICU or hospital stay > 1 week

(3) source in upper GI tract (stomach, duodenum, small bowel): yeast


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