Current Evaluation of Antibiotic Usage in Complicated Intra-Abdominal Infection after the STOP IT Trial: Did We STOP IT?

ABSTRACT

BACKGROUND: After publication of the Study to Optimize Peritoneal Infection Therapy (STOP IT) trial, we sought to determine if we were implementing study findings into practice appropriately. We had three objectives: evaluate antibiotic usage; evaluate patient outcomes; and delineate differences in antibiotic usage between general surgeons (GS) and trauma/acute care surgery trained surgeons (TACS). PATIENTS AND METHODS: This was an analysis of patients with complicated intra-abdominal infection admitted via the emergency department from February 2014 through May 2017. Complicated intra-abdominal infection (cIAI) was defined as perforated viscus, complicated appendicitis, or ischemic bowel. Patients were excluded if they had an ICD-9/10 code for diverticular/anorectal disease, did not undergo source control, or if the post-operative antibiotic course was not given or was incomplete because of withdrawal of care, change in code status, or death. Outcomes and antibiotic usage were compared before and after the STOP IT publication date. Short-course antibiotic regimens were defined as four days or less of antibiotics after source control. RESULTS: A total of 133 patients met inclusion criteria, with 47 admitted before STOP IT and 86 admitted after. Demographics and other characteristics were similar between these groups. Total antibiotic days and antibiotic days after source control decreased after STOP IT publication (p = 0.031 and p = 0.047, respectively). There were no differences in hospital length of stay (LOS), intensive care unit (ICU) LOS, surgical site infections, intra-abdominal abscesses, or death between the two groups. Short-course antibiotic compliance increased after publication from 30% to 52% (p = 0.012). Compared with GS, patients managed by TACS had decreased total antibiotic days (p = 0.030) and antibiotic days after source control (p = 0.025). CONCLUSION: We demonstrated decreased antibiotic days and increased use of short-course antibiotic regimens for patients with cIAI after the publication of STOP IT. However, there still appears to be opportunity for improved adherence to short-course regimens, as well as opportunities to educate our colleagues.