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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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“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)
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Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935
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How to use biomarkers of infection or sepsis at the bedside: guide to clinicians
Póvoa, P. M. S. R., Coelho, L., Dal‐Pizzol, F., Ferrer, R., Huttner, A., Morris, A. C., Junior, V. A. N., Ramírez, P., Rouzé, A., Salluh, J. I., et al. (2023) · Intensive Care Medicine · doi:10.1007/s00134-022-06956-y · Cited by 313
Metadata
- 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
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Surgery › 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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