Association of Excessive Duration of Antibiotic Therapy for Intra-Abdominal Infection with Subsequent Extra-Abdominal Infection and Death: A Study of 2,552 Consecutive Infections

Riccio, Lin M.; Popovsky, Kimberley A.; Hranjec, Tjasa; Politano, Amani D.; Rosenberger, Laura H.; Tura, Kristin C.; Sawyer, Robert G.

doi:10.1089/sur.2012.077

Cited by 58 publications

(46 citation statements)

References 15 publications

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“…Approximately 300,000 cases of appendicitis occur each year in the United States, 1 and at least twice that many cases of non-appendiceal infection require management. 2 Morbidity ranges from 5% among patients evaluated in broad observational studies 2–4 to close to 50% in some cohorts, such as the elderly or critically ill. 5,6 Despite the diversity of specific processes in these infections, the basic tenets of management are similar: resuscitate patients who have the systemic inflammatory response syndrome (SIRS), control the source of contamination, remove most of the infected or necrotic material, and administer antimicrobial agents to eradicate residual pathogens. 7,8 …”

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confidence: 99%

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Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

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BACKGROUND The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P = 0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

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“…4,10,11 One reason that shortening therapy has been difficult is the 20% rate of clinically significant infectious complications after treatment. 3 These subsequent complications, however, are often due to progression of the original disease or inadequate original source control and may not be preventable with antimicrobial therapy alone.…”

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Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

et al. 2015

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“…16 Currently, the average duration of antibiotic therapy for intraabdominal infection is 10 to 14 days. 4,10,11 The results of smaller studies of the effect of an abbreviated course of antimicrobial therapy have been published. Schein et al reported on an uncontrolled study in which 23 consecutive patients with diffuse peritonitis were assigned to receive 3 to 5 days of antibiotics.…”

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confidence: 99%

“…Approximately 300,000 cases of appendicitis occur each year in the United States, 1 and at least twice that many cases of non-appendiceal infection require management. 2 Morbidity ranges from 5% among patients evaluated in broad observational studies [2][3][4] to close to 50% in some cohorts, such as the elderly or critically ill. 5,6 Despite the diversity of specific processes in these infections, the basic tenets of management are similar: resuscitate patients who have the systemic inflammatory response syndrome (SIRS), control the source of contamination, remove most of the infected or necrotic material, and administer antimicrobial agents to eradicate residual pathogens. 7,8 Antimicrobial therapy for the management of intraabdominal infections continues to evolve.…”

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confidence: 99%

“…7,8 Despite these recommendations, observational studies show that therapy is typically administered for 10 to 14 days. 4,10,11 One reason that shortening therapy has been difficult is the 20% rate of clinically significant infectious complications after treatment. 3 These subsequent complications, however, are often due to progression of the original disease or inadequate original source control and may not be preventable with antimicrobial therapy alone.…”

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Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

2018

N Engl J Med

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Recent developments in the surgical management of complex intra-abdominal infection

Soop

Carlson

2017

British Journal of Surgery

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Background: Current guidance on the management of sepsis often applies to infection originating from abdominal or pelvic sources, which presents specific challenges and opportunities for efficient and rapid source control. Advances made in the past decade are presented in this article.Methods: A qualitative systematic review was undertaken by searching standard literature databases for English-language studies presenting original data on the clinical management of abdominal and pelvic complex infection in adults over the past 10 years. High-quality studies relevant to five topical themes that emerged during review were included.Results: Important developments and promising preliminary work are presented, relating to: imaging and other diagnostic modalities; antimicrobial therapy and the importance of antimicrobial stewardship; the particular challenges posed by fungal sepsis; novel techniques in percutaneous and endoscopic source control; and current issues relating to surgical source control and managing the abdominal wound. Logistical challenges relating to rapid access to cross-sectional imaging, interventional radiology and operating theatres need to be addressed so that international benchmarks can be met.

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Association of Excessive Duration of Antibiotic Therapy for Intra-Abdominal Infection with Subsequent Extra-Abdominal Infection and Death: A Study of 2,552 Consecutive Infections

Abstract: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.

Cited by 58 publications

References 15 publications

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Recent developments in the surgical management of complex intra-abdominal infection

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