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Longer-Duration Antimicrobial Therapy Does Not Prevent Treatment Failure in High-Risk Patients with Complicated
Taryn E Hassinger1, Christopher A Guidry1, Ori D Rotstein2
11 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia.
Background:
Recent studies have suggested the length of treatment of intra-abdominal infections (IAIs) can be shortened without detrimental effects on patient outcomes. However, data from high-risk patient populations are lacking. We hypothesized that patients at high risk for treatment failure will benefit from a longer course of antimicrobial therapy.
Methods:
Patients enrolled in the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated retrospectively to identify risk factors associated with treatment failure, which was defined as the composite outcome of recurrent IAI, surgical site infection, or death. Variables were considered risk factors if there was a positive statistical association with treatment failure. Patients were then stratified according to the presence and number of these risk factors. Univariable analyses were performed using the Kruskal-Wallis, χ2, and Fisher exact tests. Logistic regression controlling for risk factors and original randomization group, either a fixed four-day antimicrobial regimen (experimental) or a longer course based on clinical response (control), also was performed.
Results:
We identified corticosteroid use, Acute Physiology and Chronic Health Evaluation II score ≥5, hospital-acquired infection, or a colonic source of IAI as risk factors associated with treatment failure. Of the 517 patients enrolled, 263 (50.9%) had one or two risk factors and 16 (3.1%) had three or four risk factors. The rate of treatment failure rose as the number of risk factors increased. When controlling for randomization group, the presence and number of risk factors were independently associated with treatment failure, but the duration of antimicrobial therapy was not.
Conclusions:
We were able to identify patients at high risk for treatment failure in the STOP-IT trial. Such patients did not benefit from a longer course of antibiotic administration. Further study is needed to determine the optimum duration of antimicrobial therapy in high-risk patients.
Insights
Shortening antibiotic treatment for intra-abdominal infections (IAIs) is safe, even for high-risk patients. Identifying risk factors for treatment failure helps tailor therapy duration, but longer antibiotic courses did not improve outcomes in this study.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Pharmacology
Background:
- Intra-abdominal infections (IAIs) treatment duration is being re-evaluated.
- Data on high-risk patient populations are limited.
- This study investigated if extended antimicrobial therapy benefits high-risk IAI patients.
Purpose of the Study:
- To identify risk factors for treatment failure in intra-abdominal infections (IAIs).
- To determine if a longer course of antimicrobial therapy improves outcomes for high-risk IAI patients.
Main Methods:
- Retrospective analysis of patients from the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial.
- Identification of risk factors associated with treatment failure (recurrent IAI, surgical site infection, death).
- Stratification of patients based on the number of identified risk factors and logistic regression analysis.
Main Results:
- Corticosteroid use, high APACHE II score, hospital-acquired infection, and colonic IAI source were risk factors for treatment failure.
- Treatment failure rates increased with the number of risk factors.
- Neither the presence nor the number of risk factors, nor the duration of antimicrobial therapy, independently predicted treatment failure when controlling for randomization group.
Conclusions:
- High-risk patients for treatment failure in intra-abdominal infections (IAIs) were identified.
- Extended antibiotic therapy did not demonstrate benefit in this high-risk group.
- Further research is needed to establish optimal antimicrobial therapy duration for high-risk IAI patients.
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