Rattan Rishi, Allen Casey J, Sawyer Robert G, Mazuski John, Duane Therese M, Askari Reza, Banton Kaysie L, Claridge Jeffrey A, Coimbra Raul, Cuschieri Joseph, Dellinger E Patchen, Evans Heather L, Guidry Christopher A, Miller Preston R, O'Neill Patrick J, Rotstein Ori D, West Michaela A, Popovsky Kimberley, Namias Nicholas
University of Miami Miller School of Medicine, Miami, Florida, USA.
Am Surg. 2016 Sep;82(9):860-6.
A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intra-abdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.
一项前瞻性、多中心、随机对照试验发现，对于源头控制的复杂性腹腔内感染，使用四天抗生素与较长疗程相比，结果相似。我们推测，有特定并发症危险因素的患者也会有相似的结果。将来自STOP-IT试验的肥胖、糖尿病或急性生理与慢性健康状况评分II≥15的短疗程患者与较长疗程患者进行比较。结果包括感染性并发症的发生率和发生天数、死亡率以及住院时间。肥胖和糖尿病患者在手术部位感染、复发性腹腔内感染、腹腔外感染和艰难梭菌感染的发生率和发生天数方面相似。在急性生理与慢性健康状况评分II≥15的患者中，短疗程和长疗程患者的并发症发生率相似。然而，短疗程组手术部位感染（9.5±3.4天对21.6±6.2天，P=0.010）和腹腔外感染（12.4±6.9天对21.8±6.1天，P=0.029）的诊断天数较少。所有组的死亡率和住院时间相似。对于有糖尿病、肥胖或疾病严重程度增加的患者，在源头控制的复杂性腹腔内感染中使用短疗程抗生素似乎与较长疗程有相似的结果。
