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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-02-26

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,

ABSTRACT

PurposeShortening 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.MethodsA 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.ResultsPatients 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).ConclusionShort-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 identifierNCT01311765. More... »

PAGES

300-310

Journal

TITLE

Intensive Care Medicine

ISSUE

3

VOLUME

44

Author Affiliations

  • Département d’Anesthésie-Réanimation, CHU Bichat Claude Bernard, 48 rue Henri Huchard, 75018, Paris, France
  • Département de Biostatistique, Santé Publique et Information Médicale (BIOSPIM), Hôpital Pitié-Salpêtrière, AP-HP, INSERM, UMR 1123, ECEVE, CIC-EC 1425, Sorbonne Universités, UPMC Univ Paris 06, 75013, Paris, France
  • Department of Anaesthesiology and Critical Care Medicine, St Antoine Hospital, APHP, Sorbonne Universites, UPMC Univ Paris 06, Paris, France
  • Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
  • INSERM CIC-EC 1425, Unité de Recherche Clinique, HUPNVS, CHU Bichat-Claude Bernard, APHP, Paris, France
  • Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Rennes, Rennes, France
  • Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Beaujon, Clichy, Paris Diderot Sorbonne Cite University, Paris, France
  • Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
  • Service d’Anesthésie Réanimation, CHU Brabois, Nancy, France
  • Pôle Anesthésie-Réanimation, CHU Reims, Reims, France
  • Surgical Intensive Care Unit, CHU Cochin, Paris Descartes University, Paris, France
  • Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
  • Service d’Anesthésie Réanimation Chirurgicale, CHU Besancon, Besançon, France
  • Service d’Anesthésie et Réanimation Chirurgicale, Hotel Dieu, CHU Nantes, Nantes, France
  • Service d’Anesthésie Réanimation, Hopital St Eloi, CHU Montpellier, Montpellier, France
  • Département d’Anesthésie Réanimation, CHU Angers, L’UBL, Université d’Angers, Angers, France
  • Critical Care Medicine Department, Amiens University Hospital, INSERM U1088, University of Picardy Jules Verne, Amiens, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-018-5088-x

    DOI

    http://dx.doi.org/10.1007/s00134-018-5088-x

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1101223438

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29484469


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