Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms

Nathan R. Elwood, Christopher A. Guidry, Therese M. Duane, Joseph Cuschieri, Charles H. Cook, Patrick J. O'Neill, Reza Askari, Lena M. Napolitano, Nicholas Namias, E. Patchen Dellinger, Christopher M. Watson, Kaysie L. Banton, David P. Blake, Taryn E. Hassinger, Robert G. Sawyer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: 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. Methods: 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 χ2, Fisher exact, or Kruskal-Wallis test as appropriate. The primary outcome was a composite of recurrent IAI, surgical site infection, and death. Results: A 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)376-381
Number of pages6
JournalSurgical Infections
Volume19
Issue number4
DOIs
StatePublished - May 1 2018

Fingerprint

Intraabdominal Infections
Treatment Failure
Fungi
Therapeutics
Infection
Fungal Structures
Surgical Wound Infection
Random Allocation
Candida albicans
Small Intestine
Coronary Artery Disease
Control Groups

Keywords

  • antifungal
  • antimicrobial
  • duration
  • intra-abdominal infection

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Elwood, N. R., Guidry, C. A., Duane, T. M., Cuschieri, J., Cook, C. H., O'Neill, P. J., ... Sawyer, R. G. (2018). Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms. Surgical Infections, 19(4), 376-381. https://doi.org/10.1089/sur.2017.235

Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms. / Elwood, Nathan R.; Guidry, Christopher A.; Duane, Therese M.; Cuschieri, Joseph; Cook, Charles H.; O'Neill, Patrick J.; Askari, Reza; Napolitano, Lena M.; Namias, Nicholas; Dellinger, E. Patchen; Watson, Christopher M.; Banton, Kaysie L.; Blake, David P.; Hassinger, Taryn E.; Sawyer, Robert G.

In: Surgical Infections, Vol. 19, No. 4, 01.05.2018, p. 376-381.

Research output: Contribution to journalArticle

Elwood, NR, Guidry, CA, Duane, TM, Cuschieri, J, Cook, CH, O'Neill, PJ, Askari, R, Napolitano, LM, Namias, N, Dellinger, EP, Watson, CM, Banton, KL, Blake, DP, Hassinger, TE & Sawyer, RG 2018, 'Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms', Surgical Infections, vol. 19, no. 4, pp. 376-381. https://doi.org/10.1089/sur.2017.235
Elwood, Nathan R. ; Guidry, Christopher A. ; Duane, Therese M. ; Cuschieri, Joseph ; Cook, Charles H. ; O'Neill, Patrick J. ; Askari, Reza ; Napolitano, Lena M. ; Namias, Nicholas ; Dellinger, E. Patchen ; Watson, Christopher M. ; Banton, Kaysie L. ; Blake, David P. ; Hassinger, Taryn E. ; Sawyer, Robert G. / Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms. In: Surgical Infections. 2018 ; Vol. 19, No. 4. pp. 376-381.
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AU - Elwood, Nathan R.

AU - Guidry, Christopher A.

AU - Duane, Therese M.

AU - Cuschieri, Joseph

AU - Cook, Charles H.

AU - O'Neill, Patrick J.

AU - Askari, Reza

AU - Napolitano, Lena M.

AU - Namias, Nicholas

AU - Dellinger, E. Patchen

AU - Watson, Christopher M.

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AU - Blake, David P.

AU - Hassinger, Taryn E.

AU - Sawyer, Robert G.

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N2 - Background: 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. Methods: 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 χ2, Fisher exact, or Kruskal-Wallis test as appropriate. The primary outcome was a composite of recurrent IAI, surgical site infection, and death. Results: A 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. Conclusions: 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.

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