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Randomized Controlled Trial
. 2018 Mar;44(3):300-310.
doi: 10.1007/s00134-018-5088-x. Epub 2018 Feb 26.

Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

Philippe Montravers  1   2 , Florence Tubach  3 , Thomas Lescot  4 , Benoit Veber  5 , Marina Esposito-Farèse  6 , Philippe Seguin  7 , Catherine Paugam  8 , Alain Lepape  9 , Claude Meistelman  10 , Joel Cousson  11 , Antoine Tesniere  12 , Gaetan Plantefeve  13 , Gilles Blasco  14 , Karim Asehnoune  15 , Samir Jaber  16 , Sigismond Lasocki  17 , Herve Dupont  18 ; DURAPOP Trial Group
Collaborators, Affiliations
Free article
Randomized Controlled Trial

Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

Philippe Montravers et al. Intensive Care Med. 2018 Mar.
Free article

Abstract

Purpose: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.

Methods: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up.

Results: Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041).

Conclusion: Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. CLINICALTRIALS.

Gov identifier: NCT01311765.

Keywords: Antibiotic therapy; Duration of therapy; Multidrug-resistant bacteria; Peritonitis; Postoperative intra-abdominal infection.

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