Smith Susan E, Rumbaugh Kelli A, May Addison K
1 Department of Pharmaceutical Services, Vanderbilt University Medical Center , Nashville, Tennessee.
2 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Surg Infect (Larchmt). 2017 Aug/Sep;18(6):742-750. doi: 10.1089/sur.2017.011.
The optimal duration of antimicrobial therapy for treatment of complicated intra-abdominal infections (cIAI) in critically ill surgical patients is unknown. Recent evidence suggests that a short (four-day) course of therapy may be effective, however data in severely critically ill patients are limited.
A single-center, retrospective, cohort study was conducted at a tertiary academic medical center. Adult patients admitted to the surgical intensive care unit (SICU) with cIAI between December 2011 and July 2015 were enrolled. Patients undergoing transplantation and those with less than 24 h in the SICU were excluded. Patients were divided into two groups, short (≤ 7 d) and long (> 7 d) antimicrobial therapy. The primary outcome was treatment failure, which was defined as a composite of recurrent cIAI, secondary extra-abdominal infection, and/or in-hospital mortality from any cause. Categorical and continuous data were analyzed with χ and Mann-Whitney U tests, respectively. Binary logistic regression was performed to determine factors associated with treatment failure and mortality.
Of 1,679 patients screened, 240 were included, 103 in the short and 137 in the long group. Patients in the short and long groups received a median of 5 and 14 d of therapy, respectively (p < 0.001). Treatment failure occurred less frequently with a short duration of therapy (39% versus 63%, p < 0.001) and it occurred two days sooner after source control in patients receiving the shorter courses of antimicrobial therapy (short, median 6 d, interquartile range [IQR] 3-9; long, 8 d, IQR 6-14; p < 0.001). Logistic regression demonstrated that a long duration of therapy was associated with treatment failure (odds ratio [OR] 2.186, 95% confidence interval [CI] 1.251-3.820, p = 0.006), but not with mortality (OR 0.738, 95% CI 0.329-1.655, p = 0.461).
In critically ill surgical patients with cIAI, a short duration of antimicrobial therapy after source control resulted in similar outcomes to previously published studies, providing support for the safety of this approach in critically ill patients.
重症外科患者复杂腹腔内感染（cIAI）抗菌治疗的最佳疗程尚不清楚。近期证据表明，短疗程（4天）治疗可能有效，但重症患者的数据有限。
在一家三级学术医疗中心进行了一项单中心回顾性队列研究。纳入2011年12月至2015年7月入住外科重症监护病房（SICU）且患有cIAI的成年患者。排除接受移植的患者以及在SICU住院时间少于24小时的患者。将患者分为两组，即短疗程（≤7天）和长疗程（>7天）抗菌治疗组。主要结局为治疗失败，定义为复发性cIAI、继发性腹外感染和/或任何原因导致的院内死亡的综合情况。分类数据和连续数据分别采用χ检验和Mann-Whitney U检验进行分析。进行二元逻辑回归以确定与治疗失败和死亡率相关的因素。
在筛查的1679例患者中，240例被纳入研究，短疗程组103例，长疗程组137例。短疗程组和长疗程组患者的中位治疗天数分别为5天和14天（p<0.001）。短疗程治疗时治疗失败的发生率较低（39%对63%，p<0.001），且接受短疗程抗菌治疗的患者在源头控制后两天就出现治疗失败（短疗程组，中位6天，四分位间距[IQR]3 - 9；长疗程组，8天，IQR 6 - 14；p<0.001）。逻辑回归表明，长疗程治疗与治疗失败相关（比值比[OR]2.186，95%置信区间[CI]1.251 - 3.820，p = 0.006），但与死亡率无关（OR 0.738，95%CI 0.329 - 1.655，p = 0.461）。
在患有cIAI的重症外科患者中，源头控制后短疗程抗菌治疗的结果与先前发表的研究相似，为该方法在重症患者中的安全性提供了支持。
