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Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy

Rattan, Rishi MD; Allen, Casey J. MD; Sawyer, Robert G. MD; Askari, Reza MD; Banton, Kaysie L. MD; Coimbra, Raul MD, PhD; Cook, Charles H. MD; Duane, Therese M. MD; O'Neill, Patrick J. MD, PhD; Rotstein, Ori D. MD; Namias, Nicholas MD

Journal of Trauma and Acute Care Surgery: July 2016 - Volume 81 - Issue 1 - p 108–113
doi: 10.1097/TA.0000000000001019
EAST 2016 Plenary Papers
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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.

From the Department of Surgery (R.R., C.J.A., N.N.), University of Miami Miller School of Medicine, Miami, Florida; Departments of Surgery and Public Health Sciences (R.G.S.), University of Virginia Health Systems, Charlottesville, Virginia; Department of Surgery (R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (K.L.B.), University of Minnesota Medical Center, Minneapolis, Minnesota; Department of Surgery (R.C.), University of California San Diego, San Diego, California; Department of Surgery (C.H.C.), Beth Israel Deaconnness Medical Center, Boston, Massachusetts; Department of Surgery (T.M.D.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (P.J.O.), Maricopa Integrated Health System, Phoenix, Arizona; Department of Surgery (O.D.R.), University of Toronto St. Michael's Hospital, Toronto, ON, Canada.

Submitted: December 3, 2015, Revised: January 18, 2016, Accepted: January 20, 2016, Published online: March 7, 2016.

This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma, January 12–16, 2016, in San Antonio, Texas.

Address for reprints: Nicholas Namias, MD, Ryder Trauma Center T215 (D-40), 1800 NW 10th Ave, Miami, FL 33136; email: nnamias@med.miami.edu.

© 2016 Lippincott Williams & Wilkins, Inc.