Antibiotics for Patients With a Planned Re-Laparotomy for Intra-Abdominal Infection

Area of Science:

• Infectious Diseases
• Surgical Infections
• Antimicrobial Stewardship

Background:

• Intra-abdominal infections (IAI) management requires appropriate antimicrobial therapy, with evolving evidence on optimal duration.
• The STOP-IT trial suggested shorter antibiotic courses for IAI but excluded patients needing re-laparotomy.
• Determining the recurrence risk associated with shorter antibiotic courses in patients with planned re-laparotomy is crucial.

Purpose of the Study:

• To evaluate the short-term and long-term risk of recurrent intra-abdominal infection (IAI) in patients managed with planned re-laparotomy.
• To compare IAI recurrence rates between patients receiving short-course (≤5 days) versus long-course (>5 days) antimicrobial therapy post-source control.
• To assess the impact of antimicrobial therapy duration on secondary outcomes in this specific patient population.

Main Methods:

• A single-center, retrospective, observational study was conducted on adult patients with IAI requiring planned laparotomy.
• Patients were categorized into short-course (≤5 days) and long-course (>5 days) antimicrobial therapy groups after source control.
• The primary outcome was the recurrence of IAI within 30 days, with secondary outcomes also analyzed.

Main Results:

• Of 104 eligible patients, 78 were analyzed. Baseline characteristics and clinical severity were similar between groups.
• No significant difference in IAI recurrence was observed between the short-course and long-course antimicrobial therapy groups (41.2% vs. 44.4%; p=0.781).
• No differences were found between the groups regarding secondary outcomes.

Conclusions:

• In patients with IAI managed with planned re-laparotomy, short-course antimicrobial therapy did not lead to an increased risk of IAI recurrence.
• These findings suggest that shorter antimicrobial durations may be safe and effective in select IAI patients requiring planned re-laparotomy.
• Further research may refine antimicrobial stewardship guidelines for complex intra-abdominal infections.