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Comparison of Short-Course and Conventional Antimicrobial Duration in Mild and Moderate Complicated Intra-Abdominal
P Vinodhini1, Sathasivam Sureshkumar1, Balakrishnan Gurushankari1
1Departments of Surgery & Preventive.
Objectives:
Studies have shown the feasibility of short-course antimicrobials in complicated intra-abdominal infection (CIAI) following source control procedure (SCP). This study aimed to compare postoperative complication rates in short-course (5 days) and conventional (7-10 days) duration groups after antimicrobial therapy.
Methods:
This was a single-centre, open-labelled, randomised controlled trial conducted in Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, from July 2017 to December 2019 on patients with CIAI. Patients who were haemodynamically unstable, pregnant and had non-perforated, non-gangrenous appendicitis or cholecystitis were excluded. Primary endpoints were surgical site infection (SSI), recurrent intra-abdominal infection (IAI) and mortality. Secondary endpoints included time till occurrence of composite primary outcomes, duration of antimicrobial therapy, the length of hospital stays, antimicrobial-free interval, hospital-free days at 30 day intervals and the presence of extra-abdominal infections.
Results:
Overall, 140 patients were included whose demographic and clinico-pathological details were comparable in both groups. There was no difference in SSI (37% versus 35.6%) and recurrent IAI (5.7% versus 2.8%; P = 0.76); no mortality was observed in either groups. The composite primary outcome (37% versus 35.7%) was also similar in both groups. Secondary outcomes included the duration of antimicrobial therapy (5 versus 8 days; P <0.001) and length of hospitalisation (5 versus 7 days; P = 0.014) were significant. Times till occurrence of SSI and recurrent IAI, incidence of extra-abdominal infection and resistant pathogens were comparable.
Conclusion:
Short-course antimicrobial therapy for 5 days following SCP for mild and moderate CIAI was comparable to conventional duration antimicrobial therapy, indicating similar efficacy.
Insights
Short-course antimicrobial therapy (5 days) is as effective as longer courses for complicated intra-abdominal infections after surgery. This approach reduces treatment duration and hospital stays without increasing complications.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Antimicrobial Stewardship
Background:
- Complicated intra-abdominal infections (CIAI) often require antimicrobial therapy post-surgery.
- The optimal duration of antimicrobial therapy after source control procedure (SCP) for CIAI remains debated.
- Short-course antimicrobial regimens are being explored to optimize treatment and reduce resistance.
Purpose of the Study:
- To compare postoperative complication rates between short-course (5 days) and conventional (7-10 days) antimicrobial therapy durations in CIAI patients.
- To evaluate the efficacy and safety of shorter antimicrobial treatment durations.
- To assess the impact on key clinical outcomes like surgical site infection and recurrent infection.
Main Methods:
- A single-centre, open-labelled, randomized controlled trial was conducted.
- 140 patients with CIAI were randomized into short-course (5 days) or conventional (7-10 days) antimicrobial therapy groups.
- Primary endpoints included surgical site infection (SSI), recurrent intra-abdominal infection (IAI), and mortality.
Main Results:
- No significant differences were observed in SSI (37% vs. 35.6%), recurrent IAI (5.7% vs. 2.8%), or mortality between the groups.
- The composite primary outcome was similar (37% vs. 35.7%).
- Significant reductions were noted in the duration of antimicrobial therapy (5 vs. 8 days; P <0.001) and length of hospitalisation (5 vs. 7 days; P = 0.014) in the short-course group.
Conclusions:
- Five-day antimicrobial therapy following SCP for mild to moderate CIAI is comparable in efficacy to conventional durations.
- Short-course antimicrobial therapy can safely reduce treatment duration and hospital stays.
- This supports the use of shorter antimicrobial courses in selected CIAI cases.
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