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Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal
Nathan R Elwood1, Christopher A Guidry2, Therese M Duane3
11 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia.
Background:
Fungi frequently are isolated in intra-abdominal infections (IAI). The Study to Optimize Peritoneal Infection Therapy (STOP-IT) recently suggested short-course treatment for patients with IAI. It remains unclear whether the presence of fungi in IAI affects the optimal duration of Antimicrobial therapy. We hypothesized that a shorter treatment course in IAI with fungal organisms would be associated with a higher rate of treatment failure.
Methods:
Patients enrolled in the STOP-IT trial were stratified according to the presence or absence of a fungal isolate. They were analyzed as a subgroup based on original randomization to either the control group or an experimental group that received a four-day course of Antimicrobial therapy and by comparison with those without a fungal component to their infection. Descriptive comparisons were performed using a χ2, Fisher exact, or Kruskal-Wallis test as appropriate. The primary outcome was a composite of recurrent IAI, surgical site infection, and death.
Results:
A total of 411 patients in the study (79%) had available culture data, of which 58 (14%) had positive fungal cultures. The most common organisms were Candida albicans and C. glabrata. The treatment failure rate was equivalent in the experimental and control arms (29.6% vs. 22.6%; p = 0.54). Patients with fungal isolates were more likely to have malignant disease (25.9% vs. 9.6%; p = 0.0004) and coronary artery disease (22% vs. 12%; p = 0.04), but were otherwise similar to those without fungal isolates. Patients with fungal isolates had more hospital days (median 10 vs. 7; p < 0.0001) and more days to resumption of enteral intake (median 5 vs. 3; p = 0.0006), but there was no difference in the composite outcome.
Conclusions:
Patients with IAI involving fungal organisms randomized to a shorter course of Antimicrobial therapy had no difference in the rate of treatment failure. These results suggest that the presence of fungi in IAI may not indicate independently the need for a longer course of Antimicrobial therapy.
Insights
Short-course antimicrobial therapy is effective for intra-abdominal infections (IAI) involving fungi. The presence of fungal organisms did not increase treatment failure rates in the STOP-IT trial, suggesting shorter durations are safe.
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.
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