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Published in: Intensive Care Medicine 3/2018

01-03-2018 | Original

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

Authors: Philippe Montravers, Florence Tubach, Thomas Lescot, Benoit Veber, Marina Esposito-Farèse, Philippe Seguin, Catherine Paugam, Alain Lepape, Claude Meistelman, Joel Cousson, Antoine Tesniere, Gaetan Plantefeve, Gilles Blasco, Karim Asehnoune, Samir Jaber, Sigismond Lasocki, Herve Dupont, For the DURAPOP Trial Group

Published in: Intensive Care Medicine | Issue 3/2018

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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.
Appendix
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Metadata
Title
Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial
Authors
Philippe Montravers
Florence Tubach
Thomas Lescot
Benoit Veber
Marina Esposito-Farèse
Philippe Seguin
Catherine Paugam
Alain Lepape
Claude Meistelman
Joel Cousson
Antoine Tesniere
Gaetan Plantefeve
Gilles Blasco
Karim Asehnoune
Samir Jaber
Sigismond Lasocki
Herve Dupont
For the DURAPOP Trial Group
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 3/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5088-x

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