Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases

Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases José Augusto Ribas Fortes, Tiago Zequinão, Felipe Storm Ross, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1845081/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Secondary peritonitis is closely linked to high in-hospital morbidity, which often leads to mortality in approximately 6% of cases. There is no consensus on whether a 2 g daily dose of ceftriaxone is necessary for treating peritonitis. Objective: This study aimed to compare the efficacy of ceftriaxone 1 g and 2 g daily for community-acquired intra-abdominal infection (CA-IAI). Methods: We retrospectively analyzed the non-inferiority of 1 g versus 2 g of ceftriaxone daily as empirical treatment for CA-IAI. Mortality was the primary outcome measure in this study. The secondary outcomes were hospital readmission, abdominal fistula, and antibiotic escalation. Results: Mortality and antibiotic escalation did not differ between group 1 g and 2 g (6.3% vs. 5.0%, P = 0.40; 5.8% vs. 6.2%, P = 0,89). The proportion of readmitted patients was significantly greater in the 1 g group (5.8% vs. 2.8%. P = 0.02). In the 1 g group, patients were older (45.0 vs 38.0 years, P <0.001), Charlson score was higher (P = 0.001), and the proportion of with diabetes and neoplasms was also higher (9.5% vs. 5.8%, P=0.04; 2.8% vs. 0.8%, P = 0.02), as was the population of those who received one day less of ceftriaxone treatment (P <0.001). Conclusions: Empirical treatment for CA-IAI with ceftriaxone 1 g daily in hospitalized patients was similar to that with ceftriaxone 2 g daily in terms of treatment failure. ceftriaxone peritonitis surgical infection fistula appendicitis 1. INTRODUCTION An empirical regimen of ceftriaxone associated with metronidazole remains an appropriate option for the treatment of intra-abdominal infections (CA-IAIs), such as appendicitis and cholecystitis [1]. Even in complicated cases without risk factors for extended spectrum beta-lactamases and gram-negative bacilli, ceftriaxone is a current choice [2]. In the Infectious Diseases Society of America (IDSA), ceftriaxone doses range from 1 to 4 g; however, the ideal dose has not been determined. Some studies have shown that ceftriaxone 1 g/day is as effective as ceftriaxone 2 g/day for treating certain community-acquired infections [3, 4]. A low-dose regimen is a more economical means to treating these infections [5]. Despite few conclusive studies in the context of intra-abdominal infections (IAIs), the reported evaluations support a lack of difference between doses. Notably, use of ceftriaxone 1 g/daily for bacterial infection prophylaxis in cirrhotic patients with gastrointestinal bleeding was found to be more effective than the use of quinolones[6]. Additionally, in the treatment of cirrhotic patients with spontaneous bacterial peritonitis treatment, ceftriaxone 1 g/daily was found to be similar to 2 g/daily when the outcomes were adjusted for the Model for End-Stage Liver Disease (MELD) score[7]. Considering the lack of evidence of the effect of ceftriaxone dose on the outcome of community-acquired abdominal infections, the aim of this study was to compare the clinical outcomes of patients undergoing CA-IAI treatment with ceftriaxone 1 g versus 2 g per day. 2. METHODS 2.1. Study Design This retrospective cohort study evaluated two groups of patients with CA-IAI treated with ceftriaxone 1 g or ceftriaxone 2 g. 2.2. Setting The study was conducted at two tertiary university hospital referral centers for patients with trauma. Both hospitals are located in the city of Curitiba, Brazil. The timeframe of the study was four years, ranging from January 2017 to December 2020. Follow-up occurred until death or discharge, and 30 day readmissions were analyzed. 2.3. Participants We included patients with confirmed CA-IAI according to the IDSA guidelines [8], including appendicitis, cholecystitis, cholangitis, necrotizing pancreatitis, colitis, perforated gastric or duodenal ulcer, intra-abdominal collection or abscess, diverticulitis, acute abdomen, abdominal trauma, and peritonitis. All patients were aged > 18 years and were prescribed ceftriaxone + metronidazole for at least 48h. Patients were divided into two groups according to the daily dose of ceftriaxone. The 1 g/daily group was composed patients who completed the entire treatment with a daily dose of 1 g, while the 2 g/daily group consisted of patients who completed the entire treatment with a dose of 2 g/daily, or at least the first three days of treatment with 2g/daily. Patients with intra-abdominal neoplasms, primary peritonitis, and prophylactic use of ceftriaxone were excluded. 2.4. Variables The primary outcome was global mortality, while the secondary outcomes were antibiotic therapy failure (defined as a change in ceftriaxone for a larger spectrum intravenous antibiotic), abdominal fistula, and 30-day readmission. Clinical variables and epidemiological data included age, sex, comorbidities, Charlson score, emergency surgery, duration of hospitalization and antibiotic therapy, cause of CA-IAI, and admission to the intensive care unit (ICU). 2.5. Measurement Clinical and epidemiological data were evaluated in two studies, while a third researcher was available to support and interpret the data (e.g., diagnosis of site of infection, laboratorial interpretation, fistula). All variables were extracted from electronic medical records. Ceftriaxone plus metronidazole are the drugs of choice for empirical CA-IAI therapy, in accordance with the local institutional protocol of antibiotic therapy defined by both antimicrobial stewardship programs. The decision to use 1 g versus 2 g was made by the assistant physician, even though the antimicrobial stewardship team guided the ceftriaxone 1 g regimen. Metronidazole was used 1500 mg once day. The duration of treatment depends on the infection site, clinical condition, time to surgery, and local or systemic complications. However, the protocol of both hospitals considers four days of therapy for several infections if adequate source control is achieved, according to the STOP-IT study [9]. 2.6. Statistical analysis Continuous variables were expressed as medians and interquartile ranges, while categorical variables were expressed as frequencies or percentages. Univariate analyses were performed separately for each outcome variable. P-values were calculated using the chi-square test or Fisher’s exact test for categorical variables and the Student’s t-test or Mann-Whitney U test for continuous variables, as appropriate. Variables with p values ≤ 0.05 in the univariate analysis were included in a binary multivariable logistic regression model to compare patients treated with ceftriaxone 1 g or 2 g. All variables were assessed for collinearity. A multivariable model was generated to identify independent risk factors apart from those that we mainly investigated in this study (1 g versus 2 g of ceftriaxone). 3. RESULTS 3.1. Study population In total, 965 patients met the inclusion criteria. The distribution of patients was similar between the centers, at 490 and 475 in hospitals 1 and 2, respectively. The overall median age was 41 years (28.5 – 58.0), 530 patients were men (54.9%), and 718 (74.4%) patients underwent emergency surgery. The main indications for antibiotics were acute conditions, such as cholecystitis (34.1%), appendicitis (30.1%), and abdominal trauma (17.1%). A total of 464 (48.1%) patients were included in the ceftriaxone 1 g daily group and 501 (51.9%) in the ceftriaxone 2 g daily group (Table 1). The median age was higher in the group that used 1 g daily (45.0% vs. 38.0%; p < 0.001), whereas the median duration of ceftriaxone therapy was 1 d lower in this group (p < 0.001). Among comorbidities, uncomplicated diabetes mellitus was lower in the 1 g daily group (9.5% vs. 5.8%; p = 0.04), whereas the incidence of any neoplasm was higher in this group (2.8% vs. 0.8%; p = 0.02). The proportion of patients who underwent emergency surgery due to intra-abdominal conditions was 68.3% and 80.0% (p < 0.001) in the 1 g daily and 2 g daily groups, respectively. There were no differences in acute medical conditions between the groups. 3.2. Outcomes Outcomes related to treatment failure, such as 30-day mortality (P = 0.40) and antibiotic escalation (P = 0.89), did not significantly differ between the groups, as shown in Table 2. Additionally, complications, such as abdominal fistula, were also similar between the ceftriaxone groups (P = 0.8). Patients who used 1 g daily of ceftriaxone were readmitted in 30 days twice as often as those in the 2 g daily group, due to complications related to acute medical conditions [5.8% vs. 2.8%, OR 0.46, CI 95% (0.24-0.89), P = 0.02]. 3.3. Prognosis factors Antibiotic escalation was mainly related to age, ICU admission (OR 54, CI 95% (22.8-128.7, P < 0.001), emergency surgery (OR 6.8, CI 95% (2.1-21.8, P < 0.001), and COPD (OR 7.0, 95% (1.76-27.8, P = 0.01) (Table 3). Additionally, acute medical conditions have also been demonstrated to be related to antibiotic escalation, such as abdominal trauma (OR 3.0, CI 95% (1.7-5.2, P < 0.001), abdominal abscess (OR 54 CI 95% (22.8-128.7, P < 0.001), and diverticulitis (OR 4.0, CI 95% (1.6-10.3, P = 0.008) (Table 3). Death was also related to several variables, as shown in Table 3, such as advanced age (P < 0.001), Charlson Score (P = 0.004), ICU admission (OR 107.8, 95% (33.1-350.5, P < 0.001), emergency surgery (OR 6.3, 95% (1.9-20.5, P < 0.001), COPD (OR 7.4, 95% (1.8-29.6, P = 0.01), and any neoplasm (OR 5.4, 95% (1.7-17.1, P = 0.01). Acute medical conditions, such as intra-abdominal abscess and trauma, were also important variables related to death (Table 4). Cholecystitis and appendicitis were present in a lower proportion of patients with negative outcomes (Tables 3 and 4). 4. DISCUSSION We conducted a retrospective study to assess negative outcomes in patients hospitalized for CA-IAI who empirically received 1 or 2 g of ceftriaxone daily, as antibacterial treatment. Slightly older patients who received treatment for a shorter duration were observed in group 1 g. Among the outcomes related to treatment failure, such as antibiotic escalation and 30-day mortality, the group that used 1 g daily presented similar outcomes to the group that used 2 g daily. However, we observed a significantly greater proportion of readmitted patients in this group, although no clinical data were associated with readmission. Optimizing the dose of antibiotics is one of the main tasks of stewardship programs, and it greatly affects treatment efficacy, patient safety, and supply costs. Dose optimization is especially difficult in empirical treatments, and few bacterial culture tests are available for CA-IAI in our hospitals. Furthermore, there is a lack of scientific data comparing doses for this indication, even though ceftriaxone is one of the most prescribed agents. The major risk factors for death in CA-IAI were age (median, 65 years), ICU admission, COPD, emergency surgery, intra-abdominal abscess, and any neoplasm, as shown in Table 4. Previous studies have demonstrated that the independent factors related to death are catheter-associated bloodstream infection, heart injury, and age > 65 years[10]. Despite the higher age and neoplasm frequency in the ceftriaxone 1 g group, the death rates were not higher in this group. Thus, despite certain comorbidities, such as uncomplicated diabetes and any neoplasm, being more common in the 1 g group, these variables did not influence the statistical interpretation of clinical failure (i.e., antibiotic escalation, abdominal fistula, and death). In contrast, emergency surgery was less common in the ceftriaxone 1 g group (68% vs. 80%, P < 0.001). While this difference of 12% may slightly influence the statistical interpretation of our results, previous studies have demonstrated that death after emergency abdominal surgery is independently related to age, post-abdominal complications, and septic shock, which were all similar between the ceftriaxone dosage regimens in our cohort[11, 12]. Considering the readmission rates, our cohort demonstrated a low readmission frequency (n = 41, 4.2%), mainly considering the high frequency of emergency procedures. The frequency found in our cohort was similar to the 90-day readmission rate for cholecystectomy surgeries observed in developed countries, with the majority being elective procedures (75%)[13]. Thus, the comparative rates of 5.8% versus 2.8% of 30-day readmissions in ceftriaxone 1 g and 2 g groups, respectively, are similar to the results reported in the literature, or even lower, if we consider 7% as the expected 30 day-readmission frequency[14]. For other conditions, such as community-acquired pneumonia, prior studies have more conclusively identified the non-inferiority of the 1 g daily dose of ceftriaxone when considering death, clinical cure, and general microbiological outcomes[15]. Few studies have been conducted on intra-abdominal conditions. Notably, a randomized controlled trial compared ceftriaxone (1 g daily) versus norfloxacin (400 mg twice daily) for infection prophylaxis in cirrhotic patients with gastrointestinal bleeding. One gram of ceftriaxone was found to be more effective in preventing proven or possible infection, and the proportion of events was 33% and 11% (P = 0.003) in the norfloxacin and ceftriaxone group, respectively[6]. There are few indications for increasing the dose of ceftriaxone beyond 1 g, including staphylococcal infections, hypoalbuminemia, and meningitis[4, 16]. In addition to other conditions, the duration of treatment and dosage regimens of antimicrobials are being reevaluated for abdominal infections. For instance, one trial is evaluating a reduced antimicrobial duration of 1-2 days, even in patients with complex appendicitis (i.e., gangrenous, perforated appendicitis, or abscess) [17, 18]. Trials such as these are important given concerns regarding increasing antimicrobial resistance rates, even in community settings. Thus, re-evaluation of treatment duration and dosage regimens is considered a cornerstone to backward bacterial resistance in both hospital and community settings. Dosage regimens are commonly prescribed without evaluation of pharmacokinetics-pharmacodynamics (PK-PD) parameters, from the patient or the literature. For instance, considering ceftriaxone 1 g q24h, the free ceftriaxone blood concentration remains 100% of the time above the MIC value of the main gram-negative bacilli and Streptococcus spp. (i.e., 1 mg/L), even in critically ill patients[19]. Nevertheless, higher dosage regimens of at least 1 g q12h are needed to treat S. aureus, whose MIC values are usually between 4-8 mg/L [4]. Thus, ASP may improve prescriptions based on PK-PD parameters and decrease both environmental resistance selective pressure (e.g., ESBL) and hospital costs due to unnecessary higher ceftriaxone dosage regimens. This study has several limitations, the most important of which was its retrospective design, as the study was not a randomized clinical trial. However, considering the pharmacoeconomic approach of the antimicrobial stewardship program in both institutions in this study, this kind of study would not be approved. However, this is possible for other institutes. The patient baseline characteristics also differed between the two groups, which could be a bias for the outcomes. Minor limitations include a lack of culture in most procedures and heterogeneity of surgical procedures. In summary, ceftriaxone 1 g can be used to effectively treat CA-IAI. This lower dose regimen, in comparison with 2 g, is safe and provides a pharmacoeconomic approach for antimicrobial stewardship programs. [20] Declarations ACKNOWLEDGEMENTS None. Ethical Approval: This study was approved by the Ethical Committee from PUCPR (CAAE: 28859719.3.0000.0020). Consent to Participate: N/A. Consent to Publish: All authors approved the final version of this manuscript. Author Contributions: FFT (data analysis and final review of the manuscript), FSR and GDTM (data collection and manuscript draft), DOS (draft version of the manuscript), TZ (data analysis, results, manuscript draft); JPT (data review and final version of the manuscript). Funding: None. Competing Interests: None. Availability of data and materials: All data are available under request. Transparency declarations All authors did not receive funds References Tan A, Rouse M, Kew N et al. The appropriateness of ceftriaxone and metronidazole as empirical therapy in managing complicated intra-abdominal infection-experience from Western Health, Australia. PeerJ 2018; 6 : e5383. Solomkin JS, Mazuski JE, Bradley JS et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 : 133-64. Telles JP, Cieslinski J, Gasparetto J et al. Efficacy of Ceftriaxone 1 g daily Versus 2 g daily for The Treatment of Community-Acquired Pneumonia: A Systematic Review with Meta-Analysis. Expert Rev Anti Infect Ther 2019; 17 : 501-10. Telles JP, Leme RCP, Campos ML et al. 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Baseline Characteristics of Patients Characteristic CRO 1g daily (n=464) CRO 2g daily (n=501) P value Median age (IQR) - yr 45.0 (30.0 - 61.0) 38.0 (27.0 - 54.0) < 0.001 Male sex - no 253 (54.5%) 277 (55.3%) 0.85 Median length of stay (IQR) - days 4.0 (2.0 - 7.0) 4.0 (2.0 - 7.0) 0.56 Median length of CRO therapy (IQR) - days 3.0 (2.0 - 5.0) 4.0 (3.0 - 6.0) < 0.001 Median Charlson Score (min - max) 0.0 (0.0 - 8.0) 0.0 (0.0 - 6.0) * Comorbidities - no - - - History of AMI 8 (1.7%) 4 (0.8%) 0.25 Heart failure III 7 (1.5%) 6 (1.2%) 0.78 Peripheral Vascular Disease 7 (1.5%) 3 (0.6%) 0.20 Cerebrovascular disease 12 (2.6%) 9 (1.8%) 0.51 Dementia 2 (0.4%) 2 (0.4%) > 0.999 COPD 6 (1.3%) 4 (0.8%) 0.53 Rheumatologic conditions 3 (0.6%) 6 (1.2%) 0.51 History of peptic ulcer 5 (1,1%) 3 (0.6%) 0.49 Mild liver disease 3 (0.6%) 4 (0.8%) > 0.999 Uncomplicated DM 44 (9,5%) 29 (5,8%) 0.04 Complicated DM 3 (0.6%) 1 (0.2%) 0.36 Chronic renal failure under dialysis 2 (0.4%) 1 (0.2%) 0.61 Hemiplegy 3 (0.6%) 1 (0.2%) 0.36 Any neoplasm 13 (2.8%) 4 (0.8%) 0.02 Leukaemia 0 (0%) 0 (0%) > 0.999 Lymphoma 0 (0%) 0 (0%) > 0.999 Metastatic tumor 4 (0.9%) 0 (0%) 0.05 Cirrosis hepatic encefalopathy 0 (0%) 0 (0%) > 0.999 HIV with AIDS 3 (0.64%) 3 (0.6%) > 0.999 Emergency surgery 317 (68.3%) 401 (80.0%) < 0.001 ICU admissons 94 (20.3%) 84 (16.8%) 0.18 Median ICU days - (min - max) 0.0 (0.0 - 37.0) 0.0 (0.0 - 73.0) 0.28 Acute medical condition - no - - - Cholecystitis 157 (33.8%) 172 (34.3%) 0.89 Appendicitis 131 (28.2%) 159 (31.7%) 0.23 Abdominal trauma 82 (17.6%) 83 (16.5%) 0.67 Acute abdomen 27 (5.8%) 21 (4.2%) 0.30 Intra-abdominal collection or abscess 22 (4.7%) 15 (3.0%) 0.18 Perforated gastric or duodenal ulcer 18 (3.9%) 26 (5.2%) 0.36 Colitis or diverticulitis 13 (2.8%) 18 (3.6%) 0.58 Pancreatitis 9 (1.9%) 5 (1.0%) 0.28 Other abdominal conditions 5 (1.1%) 2 (0,4%) 0.27 CRO. Ceftriaxone; IQR. Interquartile range; AMI. Acute myocardial infarction; COPD. Chronic obstructive pulmonary disease; DM. Diabetes mellitus; HIV. human immunodeficiency virus; ICU. Intensive care unit. *P value was not calculate due to 0 value. Table 2. Outcomes comparison between groups Outcomes CRO 1g daily (n=464) CRO 2g daily (n=501) P value 30-day mortality 29 (6.3%) 25 (5.0%) 0.40 30-day any readmission 27 (5.8%) 14 (2.8%) 0.02 Abdominal fistula 8 (1.7%) 7 (1.4%) 0.80 Antibiotic escalation 27 (5.8%) 31 (6.2%) 0.89 Escalation antibiotic therapy Meropenem 3 (11.1%) 3 (9.7%) > 0.999 Cefepime 9 (33.3%) 18 (58.1%) 0.07 Piperacillin tazobactam 1 (3.7%) 0 (0%) 0.47 Levofloxacin 0 (0%) 1 (3.2%) > 0.999 Combination of 2 antibiotics 8 (29.6%) 8 (25.8%) 0.80 Combination of 3 antibiotics 6 (22.2%) 1 (3.2%) 0.04 CRO. Ceftriaxone Table 3. Baseline Characteristics of Patients - Antibiotic Escalation Cases Characteristic Antibiotic Escalation (n = 58) No antibiotic Escalation (n = 906) p Mean age (SD) - yr 48.7 (21.3) 43.8 (18.1) 0.047 Male sex - no 40 (69.0%) 489 (54.0%) 0.029 Mean duration of hospitalization (SD) - days 32.1 (26.1) 5.5 (7.9) <0.001 Mean duration of ceftriaxone therapy (SD) - days 6.1 (3.1) 4.2 (2.5) <0.001 COPD 3 (5.1%) 7 (0.77%) 0.01 Emergency surgery 55 (95%) 662 (73%) <0.001 ICU admissons 52 (90%) 125 (13%) <0.001 Mean ICU days (SD) 16.1 (17.8) 0.8 (2.9) <0.001 Acute medical condition - no Cholecystitis 9 (15.5%) 320 (35.2%) 0.001 Abdominal trauma 21 (36.2%) 144 (15.9%) <0.001 Intra-abdominal collection or abscess 6 (10.3%) 31 (3.4%) 0.02 Perforated gastric or duodenal ulcer 6 (10.3%) 37 (4%) 0.04 Colitis or diverticulitis 6 (10.3%) 25 (2.7%) 0.008 Other abdominal conditions 3 (5.1%) 4 (0.4%) 0.006 Table 4. Baseline Characteristics of Patients - Mortality Cases Characteristic Mortality (n = 55) No Mortality (n = 910) p Mean age (SD) - yr 64.6 (20.5) 42.8 (17.5) <0.001 Mean duration of hospitalization (SD) - days 17.0 (22.3) 6.6 (11.4) <0.001 Median Charlson Score (min - max) 0.0 (0-8) 0.0 (0-8) 0.004 COPD 3 (5.4%) 7 (0.7%) 0.01 Any neoplasm 4 (7.2%) 13 (1.4%) 0.01 Emergency surgery 52 (94%) 666 (73%) <0.001 ICU admissons 52 (94%) 126 (13%) <0.001 Mean ICU days (SD) 12.7 (16.8) 1.1 (4.5) <0.001 Acute medical condition - no Cholecystitis 7 (12.7%) 322 (35.3%) <0.001 Appendicitis 1 (1.8%) 289 (31.7%) <0.001 Abdominal trauma 18 (32.7%) 147 (16.1%) 0.003 Intra-abdominal collection or abscess 8 (14.5%) 29 (3.18%) <0.001 Perforated gastric or duodenal ulcer 6 (10.9%) 38 (4.1%) 0.03 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1845081","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617888666,"identity":"0a92676b-b740-498e-a096-2572b837088f","order_by":0,"name":"José Augusto Ribas Fortes","email":"","orcid":"","institution":"Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Augusto Ribas","lastName":"Fortes","suffix":""},{"id":617888667,"identity":"14d79772-ab68-48ed-a27b-9a7490815f17","order_by":1,"name":"Tiago Zequinão","email":"","orcid":"","institution":"Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Tiago","middleName":"","lastName":"Zequinão","suffix":""},{"id":617888668,"identity":"5b4e30bb-5847-4ccb-aa96-7ef6ea229138","order_by":2,"name":"Felipe Storm Ross","email":"","orcid":"","institution":"Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Felipe","middleName":"Storm","lastName":"Ross","suffix":""},{"id":617888669,"identity":"5413cc05-1e70-45c0-9441-03da35f6da3c","order_by":3,"name":"Gabriel Marinho","email":"","orcid":"","institution":"Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Gabriel","middleName":"","lastName":"Marinho","suffix":""},{"id":617888670,"identity":"40a142f4-b6c3-4aa9-8fb0-5ac24e38868a","order_by":4,"name":"Dayana dos Santos Oliveira","email":"","orcid":"","institution":"Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Dayana","middleName":"dos Santos","lastName":"Oliveira","suffix":""},{"id":617888671,"identity":"433d874b-550f-451e-8ec6-04d326794858","order_by":5,"name":"Joao Paulo Telles","email":"","orcid":"","institution":"Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Joao","middleName":"Paulo","lastName":"Telles","suffix":""},{"id":617888672,"identity":"072f44ae-9a94-4dc7-b6cd-cd0ade4be738","order_by":6,"name":"Felipe Francisco Tuon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBAC9gbmhgNQNuMDCM2DXwvPAUawFgkgZjYgWgsDVAubBHFa2BsbDxdUMNQZHO89Vl3YZpdn3sB77ANeLTwHGw7POMMgYXDmXNrtmW3JxTIH+JJn4NNiL5HYcJi3DajlRo7Zbd62A4kzGHiM8TtM/iFQyz+IlmLitEgwArU0QLQwE6eFB+iwGcckJGeeOWMsPeNccrEEM18yfi3shw9/Lqix4ec73mP4uaDMLk+CvfcwXi0gwAyJFjCDIQFMEqEFwUggQsMoGAWjYBSMMAAALapEH8YL460AAAAASUVORK5CYII=","orcid":"","institution":"Pontifícia Universidade Católica do Paraná","correspondingAuthor":true,"prefix":"","firstName":"Felipe","middleName":"Francisco","lastName":"Tuon","suffix":""}],"badges":[],"createdAt":"2022-07-11 04:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1845081/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1845081/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[],"financialInterests":"No competing interests reported.","formattedTitle":"Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eAn empirical regimen of ceftriaxone associated with metronidazole remains an appropriate option for the treatment of intra-abdominal infections (CA-IAIs), such as appendicitis and cholecystitis\u0026nbsp;[1]. Even in complicated cases without risk factors for extended spectrum beta-lactamases and gram-negative bacilli, ceftriaxone is a current choice\u0026nbsp;[2]. In the Infectious Diseases Society of America (IDSA), ceftriaxone doses range from 1 to 4 g; however, the ideal dose has not been determined.\u003c/p\u003e\n\u003cp\u003eSome studies have shown that ceftriaxone 1 g/day is as effective as ceftriaxone 2 g/day for treating certain community-acquired infections\u0026nbsp;[3, 4]. A low-dose regimen is a more economical means to treating these infections\u0026nbsp;[5]. Despite few conclusive studies in the context of intra-abdominal infections (IAIs), the reported evaluations support a lack of difference between doses. Notably, use of ceftriaxone 1 g/daily for bacterial infection prophylaxis in cirrhotic patients with gastrointestinal bleeding was found to be more effective than the use of quinolones[6]. Additionally, in the treatment of cirrhotic patients with spontaneous bacterial peritonitis treatment, ceftriaxone 1 g/daily was found to be similar to 2 g/daily when the outcomes were adjusted for the Model for End-Stage Liver Disease (MELD) score[7].\u003c/p\u003e\n\u003cp\u003eConsidering the lack of evidence of the effect of ceftriaxone dose on the outcome of community-acquired abdominal infections, the aim of this study was to compare the clinical outcomes of patients undergoing CA-IAI treatment with ceftriaxone 1 g versus 2 g per day.\u003c/p\u003e"},{"header":"2.\tMETHODS","content":"\u003cp\u003e\u003cem\u003e2.1. Study Design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study evaluated two groups of patients with CA-IAI treated with ceftriaxone 1 g or ceftriaxone 2 g.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2. Setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at two tertiary university hospital referral centers for patients with trauma. Both hospitals are located in the city of Curitiba, Brazil. The timeframe of the study was four years, ranging from January 2017 to December 2020. Follow-up occurred until death or discharge, and 30 day readmissions were analyzed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3. Participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe included patients with confirmed CA-IAI according to the IDSA guidelines\u0026nbsp;[8], including appendicitis, cholecystitis, cholangitis, necrotizing pancreatitis, colitis, perforated gastric or duodenal ulcer, intra-abdominal collection or abscess, diverticulitis, acute abdomen, abdominal trauma, and peritonitis. All patients were aged \u0026gt; 18 years and were prescribed ceftriaxone + metronidazole for at least 48h. Patients were divided into two groups according to the daily dose of ceftriaxone. The 1 g/daily group was composed patients who completed the entire treatment with a daily dose of 1 g, while the 2 g/daily group consisted of patients who completed the entire treatment with a dose of 2 g/daily, or at least the first three days of treatment with 2g/daily. Patients with intra-abdominal neoplasms, primary peritonitis, and prophylactic use of ceftriaxone were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.4. Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was global mortality, while the secondary outcomes were antibiotic therapy failure (defined as a change in ceftriaxone for a larger spectrum intravenous antibiotic), abdominal fistula, and 30-day readmission. Clinical variables and epidemiological data included age, sex, comorbidities, Charlson score, emergency surgery, duration of hospitalization and antibiotic therapy, cause of CA-IAI, and admission to the intensive care unit (ICU).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.5. Measurement\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eClinical and epidemiological data were evaluated in two studies, while a third researcher was available to support and interpret the data (e.g., diagnosis of site of infection, laboratorial interpretation, fistula). All variables were extracted from electronic medical records.\u003c/p\u003e\n\u003cp\u003eCeftriaxone plus metronidazole are the drugs of choice for empirical CA-IAI therapy, in accordance with the local institutional protocol of antibiotic therapy defined by both antimicrobial stewardship programs. The decision to use 1 g versus 2 g was made by the assistant physician, even though the antimicrobial stewardship team guided the ceftriaxone 1 g regimen. Metronidazole was used 1500 mg once day. The duration of treatment depends on the infection site, clinical condition, time to surgery, and local or systemic complications. However, the protocol of both hospitals considers four days of therapy for several infections if adequate source control is achieved, according to the STOP-IT study\u0026nbsp;[9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.6. Statistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were expressed as medians and interquartile ranges, while categorical variables were expressed as frequencies or percentages. Univariate analyses were performed separately for each outcome variable. P-values were calculated using the chi-square test or Fisher’s exact test for categorical variables and the Student’s t-test or Mann-Whitney U test for continuous variables, as appropriate. Variables with p values ≤ 0.05 in the univariate analysis were included in a binary multivariable logistic regression model to compare patients treated with ceftriaxone 1 g or 2 g. All variables were assessed for collinearity. A multivariable model was generated to identify independent risk factors apart from those that we mainly investigated in this study (1 g versus 2 g of ceftriaxone).\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003e\u003cem\u003e3.1. Study population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 965 patients met the inclusion criteria. The distribution of patients was similar between the centers, at 490 and 475 in hospitals 1 and 2, respectively. The overall median age was 41 years (28.5 \u0026ndash; 58.0), 530 patients were men (54.9%), and 718 (74.4%) patients underwent emergency surgery. The main indications for antibiotics were acute conditions, such as cholecystitis (34.1%), appendicitis (30.1%), and abdominal trauma (17.1%).\u003c/p\u003e\n\u003cp\u003eA total of 464 (48.1%) patients were included in the ceftriaxone 1 g daily group and 501 (51.9%) in the ceftriaxone 2 g daily group (Table 1). The median age was higher in the group that used 1 g daily (45.0% vs. 38.0%; p \u0026lt; 0.001), whereas the median duration of ceftriaxone therapy was 1 d lower in this group (p \u0026lt; 0.001). Among comorbidities, uncomplicated diabetes mellitus was lower in the 1 g daily group (9.5% vs. 5.8%; p = 0.04), whereas the incidence of any neoplasm was higher in this group (2.8% vs. 0.8%; p = 0.02). The proportion of patients who underwent emergency surgery due to intra-abdominal conditions was 68.3% and 80.0% (p \u0026lt; 0.001) in the 1 g daily and 2 g daily groups, respectively. There were no differences in acute medical conditions between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.2. Outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Outcomes related to treatment failure, such as 30-day mortality (P = 0.40) and antibiotic escalation (P = 0.89), did not significantly differ between the groups, as shown in Table 2. Additionally, complications, such as abdominal fistula, were also similar between the ceftriaxone groups (P = 0.8). Patients who used 1 g daily of ceftriaxone were readmitted in 30 days twice as often as those in the 2 g daily group, due to complications related to acute medical conditions [5.8% vs. 2.8%, OR 0.46, CI 95% (0.24-0.89), P = 0.02].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.3. Prognosis factors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic escalation was mainly related to age, ICU admission (OR 54, CI 95% (22.8-128.7, P \u0026lt; 0.001), emergency surgery (OR 6.8, CI 95% (2.1-21.8, P \u0026lt; 0.001), and COPD (OR 7.0, 95% (1.76-27.8, P = 0.01) (Table 3). Additionally, acute medical conditions have also been demonstrated to be related to antibiotic escalation, such as abdominal trauma (OR 3.0, CI 95% (1.7-5.2, P \u0026lt; 0.001), abdominal abscess (OR 54 CI 95% (22.8-128.7, P \u0026lt; 0.001), and diverticulitis (OR 4.0, CI 95% (1.6-10.3, P = 0.008) (Table 3).\u003c/p\u003e\n\u003cp\u003eDeath was also related to several variables, as shown in Table 3, such as advanced age (P \u0026lt; 0.001), Charlson Score (P = 0.004), ICU admission (OR 107.8, 95% (33.1-350.5, P \u0026lt; 0.001), emergency surgery (OR 6.3, 95% (1.9-20.5, P \u0026lt; 0.001), COPD (OR 7.4, 95% (1.8-29.6, P = 0.01), and any neoplasm (OR 5.4, 95% (1.7-17.1, P = 0.01). Acute medical conditions, such as intra-abdominal abscess and trauma, were also important variables related to death (Table 4). Cholecystitis and appendicitis were present in a lower proportion of patients with negative outcomes (Tables 3 and 4).\u003c/p\u003e"},{"header":"4.\tDISCUSSION","content":"\u003cp\u003eWe conducted a retrospective study to assess negative outcomes in patients hospitalized for CA-IAI who empirically received 1 or 2 g of ceftriaxone daily, as antibacterial treatment. Slightly older patients who received treatment for a shorter duration were observed in group 1 g. Among the outcomes related to treatment failure, such as antibiotic escalation and 30-day mortality, the group that used 1 g daily presented similar outcomes to the group that used 2 g daily. However, we observed a significantly greater proportion of readmitted patients in this group, although no clinical data were associated with readmission. Optimizing the dose of antibiotics is one of the main tasks of stewardship programs, and it greatly affects treatment efficacy, patient safety, and supply costs. Dose optimization is especially difficult in empirical treatments, and few bacterial culture tests are available for CA-IAI in our hospitals. Furthermore, there is a lack of scientific data comparing doses for this indication, even though ceftriaxone is one of the most prescribed agents.\u003c/p\u003e\n\u003cp\u003eThe major risk factors for death in CA-IAI were age (median, 65 years), ICU admission, COPD, emergency surgery, intra-abdominal abscess, and any neoplasm, as shown in Table 4. Previous studies have demonstrated that the independent factors related to death are catheter-associated bloodstream infection, heart injury, and age \u003cu\u003e\u0026gt;\u003c/u\u003e 65 years[10]. Despite the higher age and neoplasm frequency in the ceftriaxone 1 g group, the death rates were not higher in this group. Thus, despite certain comorbidities, such as uncomplicated diabetes and any neoplasm, being more common in the 1 g group, these variables did not influence the statistical interpretation of clinical failure (i.e., antibiotic escalation, abdominal fistula, and death). In contrast, emergency surgery was less common in the ceftriaxone 1 g group (68% vs. 80%, P \u0026lt; 0.001). While this difference of 12% may slightly influence the statistical interpretation of our results, previous studies have demonstrated that death after emergency abdominal surgery is independently related to age, post-abdominal complications, and septic shock, which were all similar between the ceftriaxone dosage regimens in our cohort[11, 12].\u003c/p\u003e\n\u003cp\u003eConsidering the readmission rates, our cohort demonstrated a low readmission frequency (n = 41, 4.2%), mainly considering the high frequency of emergency procedures. The frequency found in our cohort was similar to the 90-day readmission rate for cholecystectomy surgeries observed in developed countries, with the majority being elective procedures (75%)[13]. Thus, the comparative rates of 5.8% versus 2.8% of 30-day readmissions in ceftriaxone 1 g and 2 g groups, respectively, are similar to the results reported in the literature, or even lower, if we consider 7% as the expected 30 day-readmission frequency[14].\u003c/p\u003e\n\u003cp\u003eFor other conditions, such as community-acquired pneumonia, prior studies have more conclusively identified the non-inferiority of the 1 g daily dose of ceftriaxone when considering death, clinical cure, and general microbiological outcomes[15]. Few studies have been conducted on intra-abdominal conditions. Notably, a randomized controlled trial compared ceftriaxone (1 g daily) versus norfloxacin (400 mg twice daily) for infection prophylaxis in cirrhotic patients with gastrointestinal bleeding. One gram of ceftriaxone was found to be more effective in preventing proven or possible infection, and the proportion of events was 33% and 11% (P = 0.003) in the norfloxacin and ceftriaxone group, respectively[6]. There are few indications for increasing the dose of ceftriaxone beyond 1 g, including staphylococcal infections, hypoalbuminemia, and meningitis[4, 16]. In addition to other conditions, the duration of treatment and dosage regimens of antimicrobials are being reevaluated for abdominal infections. For instance, one trial is evaluating a reduced antimicrobial duration of 1-2 days, even in patients with complex appendicitis (i.e., gangrenous, perforated appendicitis, or abscess)\u0026nbsp;[17, 18]. Trials such as these are important given concerns regarding increasing antimicrobial resistance rates, even in community settings.\u0026nbsp;Thus, re-evaluation of treatment duration and dosage regimens is considered a cornerstone to backward bacterial resistance in both hospital and community settings.\u003c/p\u003e\n\u003cp\u003eDosage regimens are commonly prescribed without evaluation of pharmacokinetics-pharmacodynamics (PK-PD) parameters, from the patient or the literature. For instance, considering ceftriaxone 1 g q24h, the free ceftriaxone blood concentration remains 100% of the time above the MIC value of the main gram-negative bacilli and Streptococcus spp. (i.e., 1 mg/L), even in critically ill patients[19]. Nevertheless, higher dosage regimens of at least 1 g q12h are needed to treat S. aureus, whose MIC values are usually between 4-8 mg/L [4]. Thus, ASP may improve prescriptions based on PK-PD parameters and decrease both environmental resistance selective pressure (e.g., ESBL) and hospital costs due to unnecessary higher ceftriaxone dosage regimens.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations, the most important of which was its retrospective design, as the study was not a randomized clinical trial. However, considering the pharmacoeconomic approach of the antimicrobial stewardship program in both institutions in this study, this kind of study would not be approved. However, this is possible for other institutes. The patient baseline characteristics also differed between the two groups, which could be a bias for the outcomes. Minor limitations include a lack of culture in most procedures and heterogeneity of surgical procedures.\u003c/p\u003e\n\u003cp\u003eIn summary, ceftriaxone 1 g can be used to effectively treat CA-IAI. This lower dose regimen, in comparison with 2 g, is safe and provides a pharmacoeconomic approach for antimicrobial stewardship programs.\u0026nbsp;[20]\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethical Committee from PUCPR (CAAE: 28859719.3.0000.0020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u0026nbsp;\u003c/strong\u003eN/A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u0026nbsp;\u003c/strong\u003eAll authors approved the final version of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eFFT (data analysis and final review of the manuscript), FSR and GDTM (data collection and manuscript draft), DOS (draft version of the manuscript), TZ (data analysis, results, manuscript draft); JPT (data review and final version of the manuscript).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data are available under request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransparency declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors did not receive funds\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTan A, Rouse M, Kew N et al. 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Trial of short-course antimicrobial therapy for intraabdominal infection. \u003cem\u003eN Engl J Med \u003c/em\u003e2015; \u003cstrong\u003e372\u003c/strong\u003e: 1996-2005.\u003c/li\u003e\n\u003cli\u003eInui T, Haridas M, Claridge JA et al. Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection. \u003cem\u003eSurgery \u003c/em\u003e2009; \u003cstrong\u003e146\u003c/strong\u003e: 654-61; discussion 61-2.\u003c/li\u003e\n\u003cli\u003eMcGillicuddy EA, Schuster KM, Davis KA et al. Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. \u003cem\u003eArch Surg \u003c/em\u003e2009; \u003cstrong\u003e144\u003c/strong\u003e: 1157-62.\u003c/li\u003e\n\u003cli\u003eFukuda N, Wada J, Niki M et al. Factors predicting mortality in emergency abdominal surgery in the elderly. \u003cem\u003eWorld J Emerg Surg \u003c/em\u003e2012; \u003cstrong\u003e7\u003c/strong\u003e: 12.\u003c/li\u003e\n\u003cli\u003eDown SK, Nicolic M, Abdulkarim H et al. Low ninety-day re-admission rates after emergency and elective laparoscopic cholecystectomy in a district general hospital. \u003cem\u003eAnn R Coll Surg Engl \u003c/em\u003e2010; \u003cstrong\u003e92\u003c/strong\u003e: 307-10.\u003c/li\u003e\n\u003cli\u003eAwolaran O, Gana T, Samuel N et al. Readmissions after laparoscopic cholecystectomy in a UK District General Hospital. \u003cem\u003eSurg Endosc \u003c/em\u003e2017; \u003cstrong\u003e31\u003c/strong\u003e: 3534-8.\u003c/li\u003e\n\u003cli\u003eHasegawa S, Sada R, Yaegashi M et al. 1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia - a propensity score analysis of data from a Japanese multicenter registry. \u003cem\u003eBMC Infect Dis \u003c/em\u003e2019; \u003cstrong\u003e19\u003c/strong\u003e: 1079.\u003c/li\u003e\n\u003cli\u003eUlldemolins M, Roberts JA, Rello J et al. The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. \u003cem\u003eClin Pharmacokinet \u003c/em\u003e2011; \u003cstrong\u003e50\u003c/strong\u003e: 99-110.\u003c/li\u003e\n\u003cli\u003evan den Boom AL, de Wijkerslooth EML, van Rosmalen J et al. Two versus five days of antibiotics after appendectomy for complex acute appendicitis (APPIC): study protocol for a randomized controlled trial. \u003cem\u003eTrials \u003c/em\u003e2018; \u003cstrong\u003e19\u003c/strong\u003e: 263.\u003c/li\u003e\n\u003cli\u003eSabbagh C, Siembida N, Dupont H et al. The value of post-operative antibiotic therapy after laparoscopic appendectomy for complicated acute appendicitis: a prospective, randomized, double-blinded, placebo-controlled phase III study (ABAP study). \u003cem\u003eTrials \u003c/em\u003e2020; \u003cstrong\u003e21\u003c/strong\u003e: 451.\u003c/li\u003e\n\u003cli\u003eGarot D, Respaud R, Lanotte P et al. Population pharmacokinetics of ceftriaxone in critically ill septic patients: a reappraisal. \u003cem\u003eBr J Clin Pharmacol \u003c/em\u003e2011; \u003cstrong\u003e72\u003c/strong\u003e: 758-67.\u003c/li\u003e\n\u003cli\u003eSeil JT, Webster TJ. Reduced Staphylococcus aureus proliferation and biofilm formation on zinc oxide nanoparticle PVC composite surfaces. \u003cem\u003eActa Biomater \u003c/em\u003e2011; \u003cstrong\u003e7\u003c/strong\u003e: 2579-84.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 1. Baseline Characteristics of Patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO 1g daily (n=464)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO 2g daily (n=501)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMedian age (IQR) - yr\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e45.0 (30.0 - 61.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.0 (27.0 - 54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMale sex - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e253 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e277 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMedian length of stay (IQR) - days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.0 (2.0 - 7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.0 (2.0 - 7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMedian length of CRO therapy (IQR) - days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.0 (2.0 - 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.0 (3.0 - 6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMedian Charlson Score (min - max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 (0.0 - 8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 (0.0 - 6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eComorbidities - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of AMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHeart failure III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePeripheral Vascular Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCerebrovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eDementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCOPD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRheumatologic conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of peptic ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (1,1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMild liver disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eUncomplicated DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e44 (9,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e29 (5,8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eComplicated DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eChronic renal failure under dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHemiplegy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAny neoplasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e13 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eLeukaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eLymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMetastatic tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCirrosis hepatic encefalopathy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHIV with AIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEmergency surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e317 (68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e401 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eICU admissons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e94 (20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e84 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMedian ICU days - (min - max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 (0.0 - 37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.0 (0.0 - 73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAcute medical condition - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCholecystitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e157 (33.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e172 (34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAppendicitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e131 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e159 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAbdominal trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e82 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e83 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAcute abdomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eIntra-abdominal collection or abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePerforated gastric or duodenal ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e26 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eColitis or diverticulitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e13 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePancreatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOther abdominal conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (0,4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" colspan=\"4\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003eCRO. Ceftriaxone; IQR. Interquartile range; AMI. Acute myocardial infarction; COPD. Chronic obstructive pulmonary disease; DM. Diabetes mellitus; HIV. human immunodeficiency virus; ICU. Intensive care unit.\u003c/p\u003e\n \u003cp\u003e*P value was not calculate due to 0 value.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2. Outcomes comparison between groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO 1g daily (n=464)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRO 2g daily (n=501)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e30-day mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e29 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e25 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e30-day any readmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e14 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAbdominal fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAntibiotic escalation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e31 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEscalation antibiotic therapy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMeropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCefepime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e18 (58.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePiperacillin tazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCombination of 2 antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCombination of 3 antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCRO. Ceftriaxone\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3. Baseline Characteristics of Patients - Antibiotic Escalation Cases\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic\u003cbr\u003e\u0026nbsp;Escalation (n = 58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo antibiotic\u0026nbsp;\u003cbr\u003e\u0026nbsp;Escalation (n = 906)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eMean age (SD) - yr\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e48.7 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e43.8 (18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eMale sex - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e40 (69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e489 (54.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eMean duration of hospitalization (SD) - days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e32.1 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5.5 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eMean duration of ceftriaxone therapy (SD) - days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e6.1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4.2 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eCOPD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e7 (0.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eEmergency surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e55 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e662 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eICU admissons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e52 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e125 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eMean ICU days (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e16.1 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.8 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eAcute medical condition - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eCholecystitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e9 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e320 (35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eAbdominal trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e21 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e144 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eIntra-abdominal collection or abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e31 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003ePerforated gastric or duodenal ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e37 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eColitis or diverticulitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e25 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 266px;\"\u003e\n \u003cp\u003eOther abdominal conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4. Baseline Characteristics of Patients - Mortality Cases\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality (n = 55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Mortality (n = 910)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eMean age (SD) - yr\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e64.6 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e42.8 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eMean duration of hospitalization (SD) - days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e17.0 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6.6 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eMedian Charlson Score (min - max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.0 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.0 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eCOPD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e7 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eAny neoplasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e13 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eEmergency surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e52 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e666 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eICU admissons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e52 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e126 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eMean ICU days (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e12.7 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eAcute medical condition - no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eCholecystitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e7 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e322 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eAppendicitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e289 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eAbdominal trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e18 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e147 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003eIntra-abdominal collection or abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e8 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e29 (3.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 256px;\"\u003e\n \u003cp\u003ePerforated gastric or duodenal ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e38 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ceftriaxone, peritonitis, surgical infection, fistula, appendicitis","lastPublishedDoi":"10.21203/rs.3.rs-1845081/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1845081/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSecondary peritonitis is closely linked to high in-hospital morbidity, which often leads to mortality in approximately 6% of cases. There is no consensus on whether a 2 g daily dose of ceftriaxone is necessary for treating peritonitis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to compare the efficacy of ceftriaxone 1 g and 2 g daily for community-acquired intra-abdominal infection (CA-IAI).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We retrospectively analyzed the non-inferiority of 1 g versus 2 g of ceftriaxone daily as empirical treatment for CA-IAI. Mortality was the primary outcome measure in this study. The secondary outcomes were hospital readmission, abdominal fistula, and antibiotic escalation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Mortality and antibiotic escalation did not differ between group 1 g and 2 g (6.3% vs. 5.0%, P = 0.40; 5.8% vs. 6.2%, P = 0,89). The proportion of readmitted patients was significantly greater in the 1 g group (5.8% vs. 2.8%. P = 0.02). In the 1 g group, patients were older (45.0 vs 38.0 years, P \u0026lt;0.001), Charlson score was higher (P = 0.001), and the proportion of with diabetes and neoplasms was also higher (9.5% vs. 5.8%, P=0.04; 2.8% vs. 0.8%, P = 0.02), as was the population of those who received one day less of ceftriaxone treatment (P \u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Empirical treatment for CA-IAI with ceftriaxone 1 g daily in hospitalized patients was similar to that with ceftriaxone 2 g daily in terms of treatment failure.\u003c/p\u003e","manuscriptTitle":"Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 08:27:22","doi":"10.21203/rs.3.rs-1845081/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45d969a5-8fd0-43df-ba96-10037bba2390","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T08:27:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 08:27:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1845081","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1845081","identity":"rs-1845081","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}