Prolonged Therapy Is Not Associated with Delayed Identification of Recurrent Intra-Abdominal Infection

Author(s):
Andrew Dulek; Jacob O’Dell; Christopher Guidry

Background:

The STOP-IT Trial identified an association between prolonged antibiotic therapy and delayed identification of recurrent intra-abdominal infection. However, this association has not been observed in other studies. The purpose of this study was to evaluate the association between recurrent intra-abdominal infections and the duration of antibiotics.

Hypothesis:

We hypothesized that longer durations of antimicrobial therapy would be associated with delayed identification of recurrent infection.

Methods:

Adult patients from 2016 to 2020 who underwent a source control procedure for a colon-related complicated intra-abdominal infection were identified. Patients not meeting the inclusion criteria were excluded. Demographics, comorbidities, post-operative antibiotic duration, and presence of secondary intra-abdominal infection were recorded. The primary outcome was the time to identification of secondary intra-abdominal infection. Delayed identification of recurrent infection was defined as 10 or more days following source control procedure. Statistical analysis using chi-square, fisher’s exact and Wilcoxon rank sum were used where appropriate.

Results:

76 of the patients identified met inclusion criteria, and 17 (22.4%) of those patients had a recurrent intra-abdominal infection. Patients with recurrent infections were slightly younger (64 vs 60 years; p= 0.01) and had lower rates pre-operative anticoagulation (50.8% vs. 17.6%; p=0.02). There were no significant differences in the initial length of antibiotic therapy following source control between the recurrent infection and non-recurrent groups. There was a significant difference in total days of antibiotic use between the two groups, with the recurrent infection group averaging 10 more days of antibiotic use than the non-recurrence group (p<0.0001). In those patients with a recurrence, there were no differences in median days to identification (9 vs 11.5 days; p= 0.29) or the rate of those with delayed identification of recurrent infection for patients who recieved short versus long course antibiotic regimens (44.4% vs 75%; p=0.33).

Conclusions:

Similar to the STOP-IT trial we failed to identify an association between the duration of post-operative antibiotics and recurrent infection. However, we further failed to identify an association between the prolonged post-operative courses and the timing of identification of the recurrent infection. Further evaluation is needed to determine if prolonged therapy delays the identification of recurrent infection.