Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection

Zachary C. Dietch, Therese M. Duane, Charles H. Cook, Patrick J. O'Neill, Reza Askari, Lena M. Napolitano, Nicholas Namias, Christopher M. Watson, Daniel L. Dent, Brandy L. Edwards, Puja M. Shah, Christopher A. Guidry, Stephen W. Davies, Rhett N. Willis, Robert G. Sawyer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. Methods: Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. Results: Overall, 198 (38.3%) of patients were obese (BMI ≥30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). Conclusions: Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.

Original languageEnglish (US)
Pages (from-to)412-421
Number of pages10
JournalSurgical Infections
Volume17
Issue number4
DOIs
StatePublished - Aug 1 2016

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Intraabdominal Infections
Treatment Failure
Obesity
Body Mass Index
Nonparametric Statistics
Therapeutics
Comorbidity
Surgical Wound Infection
Chi-Square Distribution
Infection
Logistic Models
Demography
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Dietch, Z. C., Duane, T. M., Cook, C. H., O'Neill, P. J., Askari, R., Napolitano, L. M., ... Sawyer, R. G. (2016). Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. Surgical Infections, 17(4), 412-421. https://doi.org/10.1089/sur.2015.213

Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. / Dietch, Zachary C.; Duane, Therese M.; Cook, Charles H.; O'Neill, Patrick J.; Askari, Reza; Napolitano, Lena M.; Namias, Nicholas; Watson, Christopher M.; Dent, Daniel L.; Edwards, Brandy L.; Shah, Puja M.; Guidry, Christopher A.; Davies, Stephen W.; Willis, Rhett N.; Sawyer, Robert G.

In: Surgical Infections, Vol. 17, No. 4, 01.08.2016, p. 412-421.

Research output: Contribution to journalArticle

Dietch, ZC, Duane, TM, Cook, CH, O'Neill, PJ, Askari, R, Napolitano, LM, Namias, N, Watson, CM, Dent, DL, Edwards, BL, Shah, PM, Guidry, CA, Davies, SW, Willis, RN & Sawyer, RG 2016, 'Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection', Surgical Infections, vol. 17, no. 4, pp. 412-421. https://doi.org/10.1089/sur.2015.213
Dietch ZC, Duane TM, Cook CH, O'Neill PJ, Askari R, Napolitano LM et al. Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. Surgical Infections. 2016 Aug 1;17(4):412-421. https://doi.org/10.1089/sur.2015.213
Dietch, Zachary C. ; Duane, Therese M. ; Cook, Charles H. ; O'Neill, Patrick J. ; Askari, Reza ; Napolitano, Lena M. ; Namias, Nicholas ; Watson, Christopher M. ; Dent, Daniel L. ; Edwards, Brandy L. ; Shah, Puja M. ; Guidry, Christopher A. ; Davies, Stephen W. ; Willis, Rhett N. ; Sawyer, Robert G. / Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. In: Surgical Infections. 2016 ; Vol. 17, No. 4. pp. 412-421.
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abstract = "Background: Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. Methods: Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. Results: Overall, 198 (38.3{\%}) of patients were obese (BMI ≥30) versus 319 (61.7{\%}) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1{\%} vs. 6.9{\%}, p = 0.36), recurrent intra-abdominal infection (16.2{\%} vs. 13.8, p = 0.46), death (1.0{\%} vs. 0.9{\%}, p = 1.0), and a composite of all complications (25.3{\%} vs. 19.8{\%}, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). Conclusions: Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.",
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AU - Duane, Therese M.

AU - Cook, Charles H.

AU - O'Neill, Patrick J.

AU - Askari, Reza

AU - Napolitano, Lena M.

AU - Namias, Nicholas

AU - Watson, Christopher M.

AU - Dent, Daniel L.

AU - Edwards, Brandy L.

AU - Shah, Puja M.

AU - Guidry, Christopher A.

AU - Davies, Stephen W.

AU - Willis, Rhett N.

AU - Sawyer, Robert G.

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N2 - Background: Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. Methods: Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. Results: Overall, 198 (38.3%) of patients were obese (BMI ≥30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). Conclusions: Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.

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