Efficacy of Combined Therapy with Nitroimidazole Drugs and Broad-Spectrum Antibiotics on Intra-Abdominal Infection: A 10 Years Real-World Cohort Study

Background: Abdominal infection still has a high mortality rate, and whether the combination of nitroimidazoles against obligate anaerobe could improve the outcome of abdominal infection remains controversial. Objective: This study aimed at exploring the clinical efficacy of broad-spectrum antibiotics combined with nitroimidazoles in the treatment of abdominal infection. Methods: Clinical data of patients with abdominal infection who received broad-spectrum antibiotics alone (BSA) or broad-spectrum antibiotics in combination with nitroimidazole (NCBSA) at a single center from June 2010 to May 2020 were retrospectively reviewed. One-to-one propensity score matching (PSM) was performed to adjust the potential differences in age, gender, APACHE II score and SOFA score of the two groups. Clinical effective rate, hospitalization days and total hospitalization costs were compared between the two groups. Meanwhile, subgroup efficacy was analyzed according to disease severity (APACH II score) and whether abdominal surgery was performed. Result: A total of 149 propensity score-matched case pairs were included in this study. There was no statistical difference in clinical effective rates between the two groups (P = 0.236). The patients in BSA group had shorter hospital stays (18d vs 27d, P = 0.001) and lower hospitalization costs (85185.7 yuan vs 187898.3 yuan, P < 0.001). However, the body temperature and PCT in patients in NCBSA group were higher than those in BSA group (P = 0.007 and P = 0.045, respectively), and CRP and WBC values in NCBSA group also were higher, but there were no significant differences between the two groups (P = 0.105 and P = 0.170, respectively). And more patients (92 vs 38) in NCBSA group underwent abdominal surgery, which indicated the infection and clinical conditons in NCBSA group were probably more severe. Subgroup analysis showed that the severity of the disease and whether the patient suffered postoperative co-infection did not affect the therapeutic effect of the two groups (P > 0.05). Conclusion: The clinical efficacy of broad-spectrum antibiotics combined with nitroimidazoles for abdominal infection was similar to that of broad-spectrum antibiotics alone, and whether the combination of nitroimidazoles in these conditions still needs more lcinical evidence.

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.