title: Patients with Complicated Intra-Abdominal Infection Presenting with Sepsis Do Not Require Longer Duration of Antimicrobial Therapy.
abstract: BACKGROUND
  A recent prospective, multicenter, randomized controlled trial found that 4 days of antibiotics after source control of complicated intra-abdominal infections resulted in similar outcomes when compared with longer duration. We hypothesized that the subset of patients presenting with sepsis have similar outcomes when treated with the shorter course of antibiotics.
  
  
  METHODS
  Patients from the STOP-IT (Study to Optimize Peritoneal Infection Therapy) trial database meeting criteria for sepsis (ie, temperature <36°C or >38°C and a WBC count <4000 cells/mm(3) or >12,000 cells/mm(3)) were analyzed. Patients had been randomized to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 calendar days of therapy (n = 45), or to receive a fixed short-course of antibiotics for 4 ± 1 calendar days (n = 67). Outcomes included incidence of and time to surgical site infection, recurrent intra-abdominal infection, Clostridium difficile infection, and extra-abdominal infections, as well as hospital days and mortality.
  
  
  RESULTS
  One hundred and twelve of the 588 patients in the STOP-IT database met criteria for sepsis and were adherent to the protocol. With regard to short- vs long-course therapy, surgical site infection (11.9% vs 8.9%; p = 0.759), recurrent intra-abdominal infection (11.9% vs 13.3%; p = 1.00), extra-abdominal infection (11.9% vs 8.9%; p = 0.759), hospital days (7.4 ± 5.5 days vs 9.0 ± 7.5 days; p = 0.188), days to recurrent intra-abdominal infection (12.5 ± 6.6 days vs 18.0 ± 8.1 days; p = 0.185), days to extra-abdominal infection (12.6 ± 5.8 days vs 17.3 ± 3.9 days; p = 0.194), and mortality (1.5% vs 0%; p = 1.00) were similar. There were no cases of C difficile infection. Days to surgical site infection (6.9 ± 3.5 days vs 21.3 ± 6.1 days; p < 0.001) were fewer in the 4-day therapy group.
  
  
  CONCLUSIONS
  There was no difference in outcomes between short and long-course antimicrobial therapy in patients with complicated intra-abdominal infection presenting with sepsis. Our findings suggest that the presence of systemic illness does not mandate a longer antimicrobial course if source control of complicated intra-abdominal infection is obtained.
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Rishi
authors.initials: R
authors.lastname: Rattan
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: University of Virginia Health System, Charlottesville, VA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: Kaysie L
authors.initials: KL
authors.lastname: Banton
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
authors.affiliation: University of California Davis, Davis, CA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Cocanour
authors.affiliation: University of California San Diego, San Diego, CA.
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.affiliation: University of Washington Harborview Medical Center, Seattle, WA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.affiliation: Virginia Commonwealth University, Richmond, VA.
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.affiliation: University of Washington Harborview Medical Center, Seattle, WA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
authors.affiliation: Washington University School of Medicine, St Louis, MO.
authors.forename: John E
authors.initials: JE
authors.lastname: Mazuski
authors.affiliation: Wake Forest-Baptist Health, Winston-Salem, NC.
authors.forename: Preston R
authors.initials: PR
authors.lastname: Miller
authors.affiliation: Abrazo West Campus, Goodyear, AZ.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Neill
authors.affiliation: University of Toronto St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Ori D
authors.initials: OD
authors.lastname: Rotstein
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL. Electronic address: nnamias@miami.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D059413:Intraabdominal Infections / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents