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

Lauren J Hochstetler1, William J Olney1,2, Jacqueline M Bishop1,2

  • 1Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA.

Surgical Infections
|February 26, 2024
PubMed

Insights

Shorter antibiotic courses (≤5 days) for intra-abdominal infections (IAI) requiring planned re-laparotomy did not increase recurrence risk compared to longer courses. This finding supports optimizing antimicrobial therapy duration in complex IAI cases.

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.
Keywords:
antibiotic durationantimicrobial stewardshipintra-abdominal infectionlaparotomyopen abdomenrecurrence

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