Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: The DURAPOP randomised clinical trial.
Open accessAbstract
Purpose Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.Methods A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up.Results Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041).Conclusion Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. CLINICALTRIALS.Gov identifier NCT01311765.
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In RCTs of intra-abdominal infection, shorter duration antimicrobial therapy showed no difference in outcomes compared with longer duration.
“Intra-abdominal | Montravers 2018 (305) | 8 days | 15 days | No difference”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as Montravers 2018 (305)
The Abstract and Discussion report that, in critically ill patients with postoperative intra-abdominal infection, 8 versus 15 days of antibiotics produced equivalent 45-day mortality and no significant difference in several other clinical outcomes. But the unqualified “No difference” overstates the results: subsequent drainages were more frequent after the shorter course, and the finding applies to this specific ICU population rather than intra-abdominal infections generally. (LLM, conf=0.86)
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- Authors
- For the DURAPOP Trial Group, Montravers, P., Tubach, F., Lescot, T., Veber, B., Esposito-Farèse, M., Seguin, P., Paugam, C., Lepape, A., Meistelman, C., Cousson, J., Tesniere, A., Plantefeve, G., Blasco, G., Asehnoune, K., Jaber, S., Lasocki, S., & Dupont, H.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Inserm (FR)
- Centre Hospitalier Régional et Universitaire de Nancy (FR)
- Centre Hospitalier Universitaire de Besançon (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Centre Hospitalier Universitaire d'Angers (FR)
- Corresponding author
- Montravers, Philippe
- ORCID
- Venue
- Intensive Care Medicine
- Published
- 2018-02-26
- Volume
- 44
- Issue
- 3
- Pages
- 300-310
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2788905391
- Semantic Scholar
- dbe977f969deb7a1c03bc9fa9985b3dc9757f50a
- Cited by
- 173
- References
- 33
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 17 · 2023: 24 · 2022: 30 · 2021: 30 · 2020: 17 · 2019: 16 · 2018: 11
- FWCI
- 11.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Funders
- French Ministery of Health-Programme Hospitalier de Recherche Clinique 2009 (AOM-09024)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- short-course antibiotic therapy, postoperative intra-abdominal infection, critically ill patients, antimicrobial stewardship, antibiotic duration, multidrug-resistant bacteria, reoperation, ICU length of stay, mortality
- MeSH terms
- Aged, Aged, 80 and over, Anti-Bacterial Agents, Female, France, Humans, Intensive Care Units, Male, Middle Aged, Obesity, Morbid, Prospective Studies, Critical Illness, Intraabdominal Infections
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