经皮引流的腹腔内感染不需要更长疗程的抗菌治疗。
Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy.
作者信息
Rattan Rishi, Allen Casey J, Sawyer Robert G, Askari Reza, Banton Kaysie L, Coimbra Raul, Cook Charles H, Duane Therese M, OʼNeill Patrick J, Rotstein Ori D, Namias Nicholas
机构信息
From the Department of Surgery (R.R., C.J.A., N.N.), University of Miami Miller School of Medicine, Miami, Florida; Departments of Surgery and Public Health Sciences (R.G.S.), University of Virginia Health Systems, Charlottesville, Virginia; Department of Surgery (R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (K.L.B.), University of Minnesota Medical Center, Minneapolis, Minnesota; Department of Surgery (R.C.), University of California San Diego, San Diego, California; Department of Surgery (C.H.C.), Beth Israel Deaconnness Medical Center, Boston, Massachusetts; Department of Surgery (T.M.D.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (P.J.O.), Maricopa Integrated Health System, Phoenix, Arizona; Department of Surgery (O.D.R.), University of Toronto St. Michael's Hospital, Toronto, ON, Canada.
出版信息
J Trauma Acute Care Surg. 2016 Jul;81(1):108-13. doi: 10.1097/TA.0000000000001019.
BACKGROUND
The length of antimicrobial therapy in complicated intra-abdominal infections (CIAIs) is controversial. A recent prospective, multicenter, randomized controlled trial found that 4 days of antimicrobial therapy after source control of CIAI resulted in similar outcomes when compared with longer duration. We sought to examine whether outcomes remain similar in the subpopulation who received percutaneous drainage for source control of CIAI.
METHODS
With the use of the STOP-IT database, patients with a CIAI who received percutaneous drainage were analyzed. Patients were randomized to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy or to receive a fixed course of antibiotics for 4 ± 1 days. Outcomes included incidence of and time to recurrent intra-abdominal infection, Clostridium difficile infection, and extra-abdominal infections as well as hospital days and mortality.
RESULTS
Of 518 enrolled patients, 129 met inclusion criteria. Baseline characteristics, including demographics, comorbidities, and severity of illness, were similar. When comparing outcomes of the 4-day group (n = 72) with those of the longer group (n = 57), rates of recurrent intra-abdominal infection (9.7% vs. 10.5%, p = 1.00), C. difficile infection (0% vs. 1.8%, p = 0.442), and hospital days (4.0 [2.0-7.5] vs. 4.0 [3.0-8.0], p = 0.91) were similar. Time to recurrent infection was shorter in the 4-day group (12.7 [6.2] days vs. 21.3 [4.2] days, p = 0.015). There was no mortality.
CONCLUSION
In this post hoc analysis of a prospective, multicenter, randomized trial, there was no difference in outcome between a shorter and longer duration of antimicrobial therapy in those with percutaneously drained source control of CIAI.
LEVEL OF EVIDENCE
Therapeutic/care management study, level IV.
背景
复杂腹腔内感染（CIAI）的抗菌治疗时长存在争议。近期一项前瞻性、多中心、随机对照试验发现，CIAI源头控制后进行4天抗菌治疗与更长疗程相比，结果相似。我们试图研究在接受经皮引流进行CIAI源头控制的亚组人群中，结果是否仍然相似。
方法
利用STOP-IT数据库，对接受经皮引流的CIAI患者进行分析。患者被随机分为两组，一组接受抗生素治疗至发热、白细胞增多和肠梗阻症状消退后2天，最长治疗10天；另一组接受固定疗程的抗生素治疗4±1天。结局指标包括腹腔内感染复发、艰难梭菌感染和腹腔外感染的发生率及发生时间，以及住院天数和死亡率。
结果
518名入组患者中，129名符合纳入标准。包括人口统计学、合并症和疾病严重程度在内的基线特征相似。将4天治疗组（n = 72）与更长疗程组（n = 57）的结果进行比较时，腹腔内感染复发率（9.7%对10.5%，p = 1.00）、艰难梭菌感染率（0%对1.8%，p = 0.442）和住院天数（4.0[2.0 - 7.5]对4.0[3.0 - 8.0]，p = 0.91）相似。4天治疗组的感染复发时间更短（12.7[6.2]天对21.3[4.2]天，p = 0.015）。无死亡病例。
结论
在这项对前瞻性、多中心、随机试验的事后分析中，对于经皮引流进行源头控制的CIAI患者，较短和较长疗程的抗菌治疗在结局上无差异。
证据水平
治疗/护理管理研究，IV级。
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