Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

May 22, 2015 at 8:55 am

N Engl J Med 2015;372:1996-2005

R.G. Sawyer and Others

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.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411162

 

N Engl J Med 2015;372:2062-2063

EDITORIALS

Antibiotics for Abdominal Sepsis

R.P. Wenzel and M.B. Edmond

From the Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (R.P.W.); and the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (M.B.E.).

Major milestones in surgery have included safe sutures to promote tissue integrity, cautery to minimize bleeding, the use of anesthesia to avoid pain, and antisepsis to prevent operative contamination. In the antibiotic era, surgical procedures for source control in abdominal sepsis have been complemented with drugs targeting persistent organisms after luminal inflammation, obstruction, or perforation.

The appropriate duration of postsurgical antibiotic therapy has been unclear.1 However, if safe, shorter courses would be desirable to minimize drug-related adverse events, the selection of antibiotic resistance, and costs….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1503936

 

2015-05 EDIT Antibiotics for Abdominal Sepsis NEJM

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones intraabdominales, Infecciones nosocomiales, Metodos diagnosticos, Sepsis. Tags: .

Pelvic Inflammatory Disease Infectious mononucleosis.


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