Is fixed short-course antimicrobial therapy justified for patients who are critically ill with intra-abdominal infections?

Takesue, Yoshio; Uchino, Motoi; Ikeuchi, Hiroki; Nakajima, Kazuhiko

doi:10.23922/jarc.2019-001

Cited by 3 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another study focusing on HAP compared the effects of a shorter (5–7 days) to a prolonged course (10–14 days) of antibiotics on clinical resolution, super-infection, 30-day, and 90-day all-cause mortality. Patients on prolonged antibiotic regimens displayed a higher rate of super-infection, while 30-day mortality was higher in the short-course group [ 145 ].…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Corona,

De Santis,

Agarossi

et al. 2023

Antibiotics

View full text Add to dashboard Cite

Introduction: Not enough data exist to inform the optimal duration and type of antimicrobial therapy against GN infections in critically ill patients. Methods: Narrative review based on a literature search through PubMed and Cochrane using the following keywords: “multi-drug resistant (MDR)”, “extensively drug resistant (XDR)”, “pan-drug-resistant (PDR)”, “difficult-to-treat (DTR) Gram-negative infection,” “antibiotic duration therapy,” “antibiotic combination therapy” “antibiotic monotherapy” “Gram-negative bacteremia”, “Gram-negative pneumonia”, and “Gram-negative intra-abdominal infection”. Results: Current literature data suggest adopting longer (≥10–14 days) courses of synergistic combination therapy due to the high global prevalence of ESBL-producing (45–50%), MDR (35%), XDR (15–20%), PDR (5.9–6.2%), and carbapenemases (CP)/metallo-β-lactamases (MBL)-producing (12.5–20%) Gram-negative (GN) microorganisms (i.e., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumanii). On the other hand, shorter courses (≤5–7 days) of monotherapy should be limited to treating infections caused by GN with higher (≥3 antibiotic classes) antibiotic susceptibility. A general approach should be based on (i) third or further generation cephalosporins ± quinolones/aminoglycosides in the case of MDR-GN; (ii) carbapenems ± fosfomycin/aminoglycosides for extended-spectrum β-lactamases (ESBLs); and (iii) the association of old drugs with new expanded-spectrum β-lactamase inhibitors for XDR, PDR, and CP microorganisms. Therapeutic drug monitoring (TDM) in combination with minimum inhibitory concentration (MIC), bactericidal vs. bacteriostatic antibiotics, and the presence of resistance risk predictors (linked to patient, antibiotic, and microorganism) should represent variables affecting the antimicrobial strategies for treating GN infections. Conclusions: Despite the strategies of therapy described in the results, clinicians must remember that all treatment decisions are dynamic, requiring frequent reassessments depending on both the clinical and microbiological responses of the patient.

show abstract

Section: Resultsmentioning

confidence: 99%

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Corona,

De Santis,

Agarossi

et al. 2023

Antibiotics

View full text Add to dashboard Cite

show abstract

“…6 Further work has demonstrated the safety and efficacy of short-course antibiotic therapy in additional cohorts, including critically ill patients, patients with sepsis on presentation, and patients who have undergone percutaneous drainage. [7][8][9] The 2017 guidelines from the Surgical Infection Society (SIS), guided by this strong trial data, recommend 4 days of antibiotic therapy after source control is attained in cIAI with source control being defined as the removal of infected fluid and tissue.…”

Section: Introductionmentioning

confidence: 99%

Trends in Antibiotic Duration for Complicated Intra-Abdominal Infections

DeCesare

Saclarides

et al. 2020

The American Surgeon™

View full text Add to dashboard Cite

Introduction The 2017 surgical infection society (SIS) guidelines recommend 4 days of antibiotic therapy after source control for complicated intra-abdominal infections (cIAIs). Inappropriate exposure to antibiotics has a negative impact on outcomes in individual patients and populations. The goal of this study was to evaluate our institution’s practice patterns and adherence to current antibiotic guidelines. Methods Medical records from 2010 to 2018 for cIAIs were examined. Complicated appendicitis and complicated diverticulitis cases were included. Exclusion criteria included other etiologies of IAIs, pediatric cases, and cancer operations. Results Fifty-nine complicated appendicitis cases and 96 complicated diverticulitis cases were identified. For all cases, antibiotic duration prior to publication of the SIS guidelines was significantly longer than post-SIS duration (appendicitis: 12.6 ± 1.1 days pre-SIS [n = 37] vs 9.0 ± 1.1 days post-SIS [n = 22], P = .01; diverticulitis: 15.1 ± 0.8 days pre-SIS [n = 49] vs 11.2 ± 0.5 post-SIS [n = 47], P = .04). Surgical management (SM) was associated with shorter duration of postsource control antibiotic exposure compared with percutaneous drainage (PD) for both appendicitis (SM 10.0 ± 1.2 days vs PD 13.4 ± 1.0 days, P = .02) and diverticulitis (SM 12.8 ± 1.5 days vs PD 16.0 ± 1.5, P = .07). Patients with complicated appendicitis received shorter duration of antibiotics when managed by acute care surgeons compared to general surgeons (8.4 ± 1.1 vs 11.9 ± 0.8, P = .02). Conclusion Despite improvements after the SIS guidelines’ publication, the antibiotic duration is still longer than recommended. Surgical intervention and management by acute care specialists were associated with a shorter duration of antibiotic exposure.

show abstract

Evaluation and management of abdominal sepsis

Sartelli

2020

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review The review focuses on the evaluation and management of abdominal sepsis. Recent findings A multitude of surgical approaches towards abdominal sepsis are practized in the world and may be associated with significant morbidity and mortality rates. Despite decades of sepsis research, no specific therapies for sepsis have emerged. Without specific therapies, the management of abdominal sepsis is based on the control of the infection and organ support. Summary Early clinical diagnosis, adequate source control to stop ongoing contamination, appropriate antibiotic therapy dictated by patient and infection risk factors, and prompt resuscitation are the cornerstones of its management.

show abstract

Is fixed short-course antimicrobial therapy justified for patients who are critically ill with intra-abdominal infections?

Cited by 3 publications

References 33 publications

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Antibiotic Therapy Strategies for Treating Gram-Negative Severe Infections in the Critically Ill: A Narrative Review

Trends in Antibiotic Duration for Complicated Intra-Abdominal Infections

Evaluation and management of abdominal sepsis

Contact Info

Product

Resources

About