Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy. Issue 1 (July 2016)

• Record Type: Journal Article
• Authors: Rattan, Rishi; Allen, Casey J.; Sawyer, Robert G.; Askari, Reza; Banton, Kaysie L.; Coimbra, Raul; Cook, Charles H.; Duane, Therese M.; O'Neill, Patrick J.; Rotstein, Ori D.; Namias, Nicholas
• Is Part Of: Journal of trauma and acute care surgery. Volume 81:Issue 1(2016:Jul.)
• Publication Date: 2016-07
• Subjects: Percutaneous drainage -- intra-abdominal infection -- sepsis -- antibiotics; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000001019
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: The length of antimicrobial therapy in complicated intra-abdominal infections (CIAIs) is controversial. A recent prospective, multicenter, randomized controlled trial found that 4 days of antimicrobial therapy after source control of CIAI resulted in similar outcomes when compared with longer duration. We sought to examine whether outcomes remain similar in the subpopulation who received percutaneous drainage for source control of CIAI. METHODS: With the use of the STOP-IT database, patients with a CIAI who received percutaneous drainage were analyzed. Patients were randomized to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy or to receive a fixed course of antibiotics for 4 ± 1 days. Outcomes included incidence of and time to recurrent intra-abdominal infection, Clostridium difficile infection, and extra-abdominal infections as well as hospital days and mortality. RESULTS: Of 518 enrolled patients, 129 met inclusion criteria. Baseline characteristics, including demographics, comorbidities, and severity of illness, were similar. When comparing outcomes of the 4-day group (n = 72) with those of the longer group (n = 57), rates of recurrent intra-abdominal infection (9.7% vs. 10.5%, p = 1.00), C. difficile infection (0% vs. 1.8%, p = 0.442), and hospital days (4.0 [2.0–7.5] vs. 4.0 [3.0–8.0], p = 0.91) were similar. Time to recurrent infection was shorter in the 4-day group (12.7 [6.2] days vs. 21.3 [4.2] days, p = 0.015). There was no mortality. CONCLUSION: In this post hoc analysis of a prospective, multicenter, randomized trial, there was no difference in outcome between a shorter and longer duration of antimicrobial therapy in those with percutaneously drained source control of CIAI. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.