Trial of short-course antimicrobial therapy for intraabdominal infection

Robert G. Sawyer, Jeffrey A. Claridge, Avery B. Nathens, Ori D. Rotstein, Therese M. Duane, Heather L. Evans, Charles H. Cook, Patrick J. O'Neill, John E. Mazuski, Reza Askari, Mark A. Wilson, Lena M. Napolitano, Nicholas Namias, Preston R. Miller, E. Patchen Dellinger, Christopher M. Watson, Raul Coimbra, Daniel L. Dent, Stephen F. Lowry, Christine S. CocanourMichaela A. West, Kaysie L. Banton, William G. Cheadle, Pamela A. Lipsett, Christopher A. Guidry, Kimberley Popovsky

Research output: Contribution to journalArticle

264 Scopus citations

Abstract

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 sourcecontrol 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.

Original languageEnglish (US)
Pages (from-to)1996-2005
Number of pages10
JournalNew England Journal of Medicine
Volume372
Issue number21
DOIs
StatePublished - May 21 2015

ASJC Scopus subject areas

  • Medicine(all)

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