Short-course antibiotic therapy in abdominal sepsis with source control: an integrative review
DOI:
https://doi.org/10.5281/zenodo.21798799Keywords:
abdominal sepsis, complicated intra-abdominal infection, short-course antibiotic therapy, source control, antibiotic treatment duration, mortality, antimicrobial resistanceAbstract
Background: Complicated intra-abdominal infection (cIAI) is a leading cause of sepsis in critical care, with variable mortality. Treatment relies on source control and systemic antibiotic therapy. Controversy over optimal duration has challenged prolonged courses (7–14 days) because of increased risk of adverse events, Clostridioides difficile infection and selection of microbial resistance. The STOP-IT trial was a milestone in demonstrating non-inferiority of a fixed four-day antibiotic course in cIAI with adequate source control. Objective: To synthesize evidence on short-course antibiotic therapy in abdominal sepsis with source control. Methods: Integrative review of clinical evidence on antibiotic duration in complicated intra-abdominal infection. Results: Short fixed courses after adequate source control are non-inferior to longer strategies for clinical outcomes in selected patients, with potential benefits regarding adverse events and antimicrobial resistance. Conclusions: After adequate source control, short antibiotic courses are a reasonable strategy in eligible patients; duration should be individualized according to clinical response and local ecology.
Downloads
References
1. Napolitano LM. Intra-abdominal infections. Semin Respir Crit Care Med. 2022;43(1):10-27. doi:10.1055/s-0041-1741053
2. Ahmed S, Wilcox MH, Kirby A. Measuring outcomes in complicated intra-abdominal infections. Curr Opin Gastroenterol. 2020;36(1):1-4. doi:10.1097/mog.0000000000000591
3. Obst W, Esser T, Kaasch AJ, Geginat G, Meyer F, Croner RS, et al. The need of antimicrobial stewardship in post-operative infectious complications of abdominal surgery. Visc Med. 2022;38(5):345-53. doi:10.1159/000526785
4. Hellyer TP, Mantle T, McMullan R, Dark P. How to optimise duration of antibiotic treatment in patients with sepsis? BMJ. 2020;371:m4357. doi:10.1136/bmj.m4357
5. Sheppard D. Short-course antibiotic therapy: the next frontier in antimicrobial stewardship. Can Commun Dis Rep. 2022;48(11-12):496-501. doi:10.14745/ccdr.v48i1112a01
6. Ng-Kamstra JS, Soo A, McBeth P, Rotstein O, Zuege DJ, Gregson D, et al. STOP signs: a population-based interrupted time series analysis of antibiotic duration for complicated intra-abdominal infection before and after the publication of a landmark RCT. Ann Surg. 2023;277(5):e984-91. doi:10.1097/sla.0000000000005231
7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
8. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. doi:10.1111/j.1365-2648.2005.03621.x
9. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. doi:10.1136/bmj.i4919
10. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898
11. Surat G, Meyer-Sautter P, Rüsch J, Braun-Feldweg J, Germer CT, Lock JF. Retrospective cohort analysis of the effect of antimicrobial stewardship on postoperative antibiotic therapy in complicated intra-abdominal infections: short-course therapy does not compromise patients' safety. Antibiotics (Basel). 2022;11(1):120. doi:10.3390/antibiotics11010120
12. Vinodhini P, Sureshkumar S, Gurushankari B, Mahalakshmy T, Kate V. Comparison of short-course and conventional antimicrobial duration in mild and moderate complicated intra-abdominal infections: a randomised controlled trial. Sultan Qaboos Univ Med J. 2023;23(2):212-9. doi:10.18295/squmj.1.2023.006
13. Ahmed S, Brown R, Pettinger R, Vargas-Palacios A, Burke D, Kirby A. The CABI trial: an unblinded parallel group randomised controlled feasibility trial of long-course antibiotic therapy (28 days) compared with short course (≤ 10 days) in the prevention of relapse in adults treated for complicated intra-abdominal infection. J Gastrointest Surg. 2021;25(4):1045-52. doi:10.1007/s11605-020-04545-2
14. Muñeton-López GA, Rodríguez LFC, Fandiño LCS, Lasso AD, Granados JPA, Salazar YID, et al. Effectiveness of five antibiotic regimens for the treatment of intra-abdominal infection in Bogotá. Surg Infect (Larchmt). 2022;23(10):933-9. doi:10.1089/sur.2022.296
15. Dulek A, O'Dell JC, Guidry CA. Prolonged therapy is not associated with delayed identification of recurrent intra-abdominal infection. Surg Infect (Larchmt). 2022;23(9):796-800. doi:10.1089/sur.2022.238
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Christirobert Goncalves Neres, Dillion Arpis Braz Ferreira, Eduardo Silva de Araújo, Lucília Maria de Oliveira Cardoso, Tainara Huane da Silva Terra, Maria Eduarda Mihok, Paola Britos (Autor/a)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Los artículos publicados en la Revista UniNorte de Medicina y Ciencias de la Salud se distribuyen bajo una licencia Creative Commons Reconocimiento 4.0 Internacional (CC BY 4.0).
Esta licencia permite a cualquier usuario copiar, distribuir, adaptar, transformar y construir a partir del material para cualquier propósito, incluso comercial, siempre que se otorgue el crédito adecuado a los autores y a la fuente original de publicación.
Los autores conservan los derechos de autor y otorgan a la revista el derecho de primera publicación.
La reutilización del contenido deberá reconocer la autoría, citar la fuente original e indicar si se han realizado modificaciones.
