Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms
| Autor: | Nathan R. Elwood, Kaysie L. Banton, Therese M. Duane, Charles H. Cook, Nicholas Namias, Christopher A. Guidry, Patrick J. O'Neill, Robert G. Sawyer, Taryn E. Hassinger, Reza Askari, Christopher M. Watson, Joseph Cuschieri, E. Patchen Dellinger, David P. Blake, Lena M. Napolitano |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) Antifungal medicine.medical_specialty Time Factors Adolescent medicine.drug_class 030106 microbiology Treatment failure Young Adult 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Drug Therapy Internal medicine medicine Humans In patient Short course Treatment Failure 030212 general & internal medicine Intra-Abdominal Infection Aged Peritoneal Infection Aged 80 and over business.industry Middle Aged Antimicrobial Infectious Diseases Mycoses Intraabdominal Infections Female Surgery business |
| Zdroj: | Surgical Infections. 19:376-381 |
| ISSN: | 1557-8674 1096-2964 |
| DOI: | 10.1089/sur.2017.235 |
| Popis: | Fungi frequently are isolated in intra-abdominal infections (IAI). The Study to Optimize Peritoneal Infection Therapy (STOP-IT) recently suggested short-course treatment for patients with IAI. It remains unclear whether the presence of fungi in IAI affects the optimal duration of Antimicrobial therapy. We hypothesized that a shorter treatment course in IAI with fungal organisms would be associated with a higher rate of treatment failure.Patients enrolled in the STOP-IT trial were stratified according to the presence or absence of a fungal isolate. They were analyzed as a subgroup based on original randomization to either the control group or an experimental group that received a four-day course of Antimicrobial therapy and by comparison with those without a fungal component to their infection. Descriptive comparisons were performed using a χA total of 411 patients in the study (79%) had available culture data, of which 58 (14%) had positive fungal cultures. The most common organisms were Candida albicans and C. glabrata. The treatment failure rate was equivalent in the experimental and control arms (29.6% vs. 22.6%; p = 0.54). Patients with fungal isolates were more likely to have malignant disease (25.9% vs. 9.6%; p = 0.0004) and coronary artery disease (22% vs. 12%; p = 0.04), but were otherwise similar to those without fungal isolates. Patients with fungal isolates had more hospital days (median 10 vs. 7; p 0.0001) and more days to resumption of enteral intake (median 5 vs. 3; p = 0.0006), but there was no difference in the composite outcome.Patients with IAI involving fungal organisms randomized to a shorter course of Antimicrobial therapy had no difference in the rate of treatment failure. These results suggest that the presence of fungi in IAI may not indicate independently the need for a longer course of Antimicrobial therapy. |
| Databáze: | OpenAIRE |
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