Current Evaluation of Antibiotic Usage in Complicated Intraabdominal Infection After the STOP IT Trial: Did We STOP IT?

Author(s):
Sarah Posillico; Brian Young; Husayn Ladhani; Brenda Zosa; Jeffrey Claridge

Background:

Our objective was to evaluate antibiotic usage for complicated intraabdominal infections (CIAI) at our institution after the publication of the STOP IT trial, to determine if we were successfully implementing these findings into practice, and to evaluate outcomes.

Hypothesis:

We hypothesized that we could demonstrate successful reduction in antibiotic course duration after publication of the STOP IT trial, with similar patient outcomes.

Methods:

This was an analysis of patients presenting to the emergency department with CIAI from February 2014 through May 2017. CIAI were defined as patients with a perforated viscus, complicated appendicitis, and ischemic bowel. Exclusion criteria were if the patient did not undergo source control, ie., either operative or radiologic intervention, if no post-operative antibiotic course was given, or if the post-operative antibiotic course was not completed due to withdrawal of care, change in code status, or death. Patient outcomes and antibiotic usage were compared before and after the publication date. For this study, antibiotic courses of 5 days or less were defined as short course (SC).

Results:

A total of 132 patients met inclusion criteria. There were 47 patients in the pre-STOP IT group, and 85 in the post-STOP IT group. These groups were well-matched in terms of demographics and other characteristics (Table 1). There was a statistically significant decrease in both total antibiotic days and antibiotic days after source control after the publication of the STOP IT trial. There were no differences in hospital length of stay (LOS), ICU LOS, surgical site infections, intraabdominal abscesses, or death between the two groups. The percentage of patients receiving SC antibiotics significantly increased after publication from 23.4% to 44.7%.

Conclusions:

This is the first study to our knowledge that attempts to evaluate the implementation of the STOP IT findings into clinical practice. We successfully demonstrated decreased antibiotic days and increased use of SC antibiotic regimens after the publication of the STOP IT trial. However, there still appears to be significant room for improved antibiotic stewardship with respect to adherence to SC antibiotic regimens.