Predicting peritoneal contamination with enterobacteria producing extended-spectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients
I.F. Shishlo1, S.A. Krasny1, Yu.N. Dolgina1
1. N.N. Alexandrov National Cancer Centre of Belarus, Minsk, the Republic of Belarus
Год: 2021 выпуск: 60 номер: 2 страницы: 4-8
Relevance: Enterobacteriaceae family microorganisms, specifically E. coli and K. pneumoniae isolates, are the most common activators of postoperative peritonitis in oncology. Many of these microorganisms produce extended-spectrum beta-lactamases (ESBL). The deemed resistance of ESBL-producing enterobacteria to all β-lactam antibiotics, except for carbapenems, leads to the ineffectiveness of empiric antibiotic therapy.
The purpose of the study was to define the risk factors of peritoneal contamination with ESBL-producing enterobacteria
for choosing optimal empirical antibacterial therapy on the example of a specific cancer patient with postoperative peritonitis.
Results: Independent risk factors of peritoneal contamination with ESBL-producing enterobacteria included “the administration of antibiotics for more than three days” (OR 106, 95% CI 21.0-537, p<0.001), “two or more repeated laparotomies” (OR 2.66, 95% CI 1.32-5.34, p=0.006), and “postoperative preventive antibiotic treatment” (OR 0.17, 95% CI 0.04-0.75, p=0.02). The obtained prognostic model allowed predicting the infection with ESBL-producing enterobacteria before establishing the postoperative peritonitis microbial etiology. The model sensitivity was 94.7%, overall predictive accuracy was 73.1. Conclusion: Prolonged administration of antibiotics (3rd-generation cephalosporins and/or fluoroquinolones) after cancer surgery to prevent surgical infections is the main independent risk factor of peritoneal contamination with ESBL- producing enterobacteria.
Ключевые слова: cancer patients, postoperative peritonitis, extended-spectrum beta-lactamases (ESBL)-producing enterobacteria, empirical antibacterial therapy (ABT), carbapenems
Ссылка: I.F. Shishlo, S.A. Krasny, Yu.N. Dolgina. Predicting peritoneal contamination with enterobacteria producing extended-spectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients. Oncology and Radiology of Kazakhstan, 2021, 60 (2), 4-8.