Abstract
Background: Recent evidence suggests that short-course postoperative antibiotic therapy (PAT) of intra-abdominal infections is non-inferior considering clinical outcomes. The aim of this study was to compare the outcome of short vs. long PAT in complicated intra-abdominal infections (cIAIs) without sepsis. Methods: We performed a single center-quality improvement study at a 1500 bed sized university hospital in Bavaria, Germany, with evaluation of the length of antibiotic therapy after emergency surgery on cIAIs with adequate source control during 2016 to 2018. We reviewed a total of 260 cases (160 short duration vs. 100 long duration). The antibiotic prescribing quality was assessed by our in-house antimicrobial stewardship team (AMS). Results: No significant differences of patient characteristics were observed between short and long PAT. The frequency of long PAT declined during the observation period from 48.1% to 26.3%. Prolongation of PAT was not linked with any clinical benefits, on the contrary clinical outcome of patients receiving longer regimes were associated with higher postoperative morbidity. AMS identified additional educational targets to improve antibiotic prescribing quality on general wards like unnecessary postoperative switches of antibiotic regimes, e.g., unrequired switches to oral antibiotics as well as prolongation of PAT due to elevated CRP. Conclusion: Short-course antibiotic therapy after successful surgical source control in cIAIs is safe, and long-duration PAT has no beneficial effects.
Highlights
Antimicrobial stewardship programs (ASPs) are gaining, globally, increasing in merited recognition and acceptance and were primarily launched to stop antimicrobial resistance (AMR) [1,2]
This time the prescribing attitudes of surgeons on general wards were the focus of our observations, within the wider ambition of discerning the influence of biochemical inflammation markers such as C-reactive protein (CRP) or procalcitonin (PCT) on the duration of postoperative antibiotic therapy (PAT)
In accordance with the data released on postsurgical antimicrobial management in complicated community acquired so far, our results support that shortened PAT is not associated with worse clinical outcomes
Summary
Antimicrobial stewardship programs (ASPs) are gaining, globally, increasing in merited recognition and acceptance and were primarily launched to stop antimicrobial resistance (AMR) [1,2]. Postantibiotic duration for complicated surgical intra-abdominal infections (cIAIs) attracts focus and motivates progressively more data suggesting that a short regimen may suffice for an optimal clinical recovery applying for both, complicated mild/moderate IAIs and severe postoperative IAIs in critically ill patients, provided source control has been achieved [14,15,16]. For cIAIs the approach encloses timely performed surgical source control with appropriate antimicrobial treatment; community or hospital acquired IAIs may be uncomplicated or complicated by definition as well [17,20,21,22]. Recent evidence suggests that short-course postoperative antibiotic therapy (PAT) of intra-abdominal infections is non-inferior considering clinical outcomes. Conclusion: Short-course antibiotic therapy after successful surgical source control in cIAIs is safe, and long-duration PAT has no beneficial effects
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