Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Surgical Infections

Background:

• Fungal organisms are common in intra-abdominal infections (IAI).
• The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial evaluated short-course antimicrobial therapy for IAI.
• The impact of fungal presence on optimal antimicrobial therapy duration in IAI is not well-defined.

Purpose of the Study:

• To investigate whether fungal isolates in IAI impact treatment failure rates with shorter antimicrobial courses.
• To test the hypothesis that fungal organisms in IAI necessitate longer antimicrobial therapy durations.

Main Methods:

• Patients from the STOP-IT trial were stratified based on the presence or absence of fungal isolates.
• Subgroup analysis compared outcomes between patients randomized to a four-day antimicrobial course versus a control group.
• The primary outcome was a composite of recurrent IAI, surgical site infection, and death.

Main Results:

• Of 411 patients with culture data, 58 (14%) had positive fungal cultures (Candida albicans, C. glabrata most common).
• Treatment failure rates were similar between experimental and control arms (29.6% vs. 22.6%, p=0.54).
• Patients with fungal isolates had longer hospital stays and delayed enteral intake resumption but no difference in the composite outcome.

Conclusions:

• Short-course antimicrobial therapy did not lead to increased treatment failure in patients with fungal IAI.
• Fungal presence in IAI does not appear to independently necessitate a longer antimicrobial treatment course.
• These findings support the use of shorter antimicrobial durations in select IAI cases, regardless of fungal involvement.