The Influence of the STOP-IT Trial on Antibiotic Prescribing in the ICU

Author(s):
Max Kopitnik; Brent Goslin; Abby Tyson; Gregory Vereb; John Elliott; Kevin Harris; Adam Smith

Background:

Complicated intraabdominal infections affect thousands of patients each year in the United States. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial concluded that intraabdominal infections with source control can be adequately treated with 4 days of antibiotics compared to a typical extended duration of 7-10 days, but did not exclusively examine patients requiring critical care management.

Hypothesis:

We suspect that patients admitted to the Surgical Intensive Care Unit after the STOP-IT trial received fewer antibiotic days, in addition to notable improvements in other outcome parameters.

Methods:

We conducted a retrospective, single-center chart review of patients who were admitted to the MICU or SICU with a diagnosis of a complicated intraabdominal infection after a definitive source control procedure. To be eligible, patients must have received at least 24 hours of antimicrobial therapy from January 1, 2014 to December 31, 2014 (pre-STOP-IT) and January 1, 2016 to January 31, 2016 (post-STOP-IT). A Chi-Square test or a Fischer’s exact test were used to compare the proportion of patients admitted to the ICU with a complicated intraabdominal infection who received 4 (±1) days of antimicrobial therapy after an adequate source control procedure.

Results:

Critical care patients admitted with intraabdominal infections in 2016 (post-STOP-IT) were more likely to receive ≤ 5 days of antibiotic therapy compared to those in 2014 (pre-STOP-IT) (47.2% vs. 27.2%, p=0.024) and fewer total days of antimicrobial therapy (7.5 days vs. 6.3 days, p = 0.020). Mortality was higher in patients receiving a longer course of antimicrobial therapy (18.7% vs. 12.5%). The rate of sepsis remained constant between 2014 and 2016 (65.9% versus 66.7%), as did the mean length of stay (14.7 days versus 14.6 days). In-hospital mortality was higher at 18.7% in 2014 compared to 12.5% in 2016.  This trended toward statistical signficance. The presence of recurrent intraabdominal infection (11.0% vs. 22.2% p = 0.056) and of clostridium difficile infections (6.6% vs 6.9%, p = 1) also remained similar between groups.

Conclusions:

Implementing a shorter duration of antimicrobial therapy in the critical care patient population results in decreased antibiotic use without increasing morbidity and mortality.