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Surg Infect (Larchmt). 2018 May/Jun;19(4):376-381. doi: 10.1089/sur.2017.235. Epub 2018 Mar 22.

Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms.

Author information

1
1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia.
2
2 Department of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
3
3 Department of Surgery, University of North Texas John Peter Smith Hospital , Fort Worth, Texas.
4
4 Department of Surgery, University of Washington , Seattle, Washington.
5
5 Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts.
6
6 Department of Surgery, Abrazo West Campus , Goodyear, Arizona.
7
7 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.
8
8 Department of Surgery, University of Michigan , Ann Arbor, Michigan.
9
9 Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida.
10
10 Department of Surgery, University of South Carolina , Columbia, South Carolina.
11
11 Department of Surgery, Univeristy of Minnesota Medical School , Minneapolis, Minnesota.
12
12 United States Air Force , Norfolk, Virginia.
13
13 Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine , Kalamazoo, Michigan.

Abstract

BACKGROUND:

Fungi frequently are isolated in intra-abdominal infections (IAI). The Study to Optimize Peritoneal Infection Therapy (STOP-IT) recently suggested short-course treatment for patients with IAI. It remains unclear whether the presence of fungi in IAI affects the optimal duration of Antimicrobial therapy. We hypothesized that a shorter treatment course in IAI with fungal organisms would be associated with a higher rate of treatment failure.

METHODS:

Patients enrolled in the STOP-IT trial were stratified according to the presence or absence of a fungal isolate. They were analyzed as a subgroup based on original randomization to either the control group or an experimental group that received a four-day course of Antimicrobial therapy and by comparison with those without a fungal component to their infection. Descriptive comparisons were performed using a χ2, Fisher exact, or Kruskal-Wallis test as appropriate. The primary outcome was a composite of recurrent IAI, surgical site infection, and death.

RESULTS:

A total of 411 patients in the study (79%) had available culture data, of which 58 (14%) had positive fungal cultures. The most common organisms were Candida albicans and C. glabrata. The treatment failure rate was equivalent in the experimental and control arms (29.6% vs. 22.6%; p = 0.54). Patients with fungal isolates were more likely to have malignant disease (25.9% vs. 9.6%; p = 0.0004) and coronary artery disease (22% vs. 12%; p = 0.04), but were otherwise similar to those without fungal isolates. Patients with fungal isolates had more hospital days (median 10 vs. 7; p < 0.0001) and more days to resumption of enteral intake (median 5 vs. 3; p = 0.0006), but there was no difference in the composite outcome.

CONCLUSIONS:

Patients with IAI involving fungal organisms randomized to a shorter course of Antimicrobial therapy had no difference in the rate of treatment failure. These results suggest that the presence of fungi in IAI may not indicate independently the need for a longer course of Antimicrobial therapy.

KEYWORDS:

Antimicrobial; antifungal; duration; intra-abdominal infection

PMID:
29565726
DOI:
10.1089/sur.2017.235
[Indexed for MEDLINE]

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