Highlights from #EAST2016 - Antibiotics for Intra-abdominal infection

More proof that only 4 days of ATB are necessary for intra-abdominal infections.

PERCUTANEOUSLY DRAINED INTRA-ABDOMINAL INFECTIONS DO NOT REQUIRE LONGER DURATION OF ANTIMICROBIAL THERAPY

Rishi Rattan, MD*, Casey J Allen, Robert Sawyer, MD*, Nicholas Namias, MD* University of Miami Miller School of Medicine

Objectives: The length of antimicrobial therapy in complicated intra-abdominal infections (CIAI) 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 to longer duration. We sought to examine whether outcomes remain similar in the subgroup of patients who received percutaneous drainage for source control of CIAI.

Methods: Using the STOP-IT database, patients age >16 years with a CIAI and either temperature >38o C, white blood cell count >11,000 cells/mm3, or peritonitis-induced gastrointestinal dysfunction 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 receive a fixed course of antibiotics for 4±1 calendar days. Outcomes included recurrent intra-abdominal infection, time to recurrent infection, Clostridium difficile infection, hospital days, and mortality.

Results: Of 129 patients identified, 72 received a 4-day course of antibiotics and 57 patients received a longer course. Baseline characteristics, including demographics, comorbidities, and severity of illness were similar. When comparing outcomes of the 4-day group to the longer group, rates of recurrent intra-abdominal infection (9.7 vs 10.5%, p=1.00), Clostridium 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 vs 21.3±4.2 days, p=0.015). There was no mortality.

Conclusions: In this 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 a CIAI.