Saturday, June 6, 2015

This study is boring, and we need more just like it

What is there to say about a study that compares the treatment of an infection with X versus Y days of antibiotics? The recently published STOP-IT trial didn’t reveal groundbreaking new approaches to treatment or prevention, or provide keen insights into pathogenesis or transmission. The investigators simply compared two antibiotic treatment durations for abdominal sepsis: a short course after source control (~4 days), versus a more standard course that continued until fever, elevated white cell count and ileus had resolved for 2 days or so (to a maximum of 10 days). The verdict? No difference in outcomes (a composite of surgical site infection, recurrent intraabdominal infection, or death within 30 days). Our own Mike Edmond and Dick Wenzel penned the excellent accompanying editorial, to which I refer you for more detailed commentary.

I like this study, and we clearly need more studies that test our current approaches to antimicrobial treatment of common infections. “How long do we need to treat this infection?” is one of the most frequent questions we get as ID consultants, and it’s amazing how scant the evidence base is regarding duration of therapy. Studies like this one, and this oft-cited study that helped reduce our duration of treatment for ventilator-associated pneumonia, have the potential to markedly reduce unnecessary antimicrobial therapy, thereby reducing risk for C. difficile and antimicrobial resistance emergence, among other adverse effects of antimicrobial overuse.

Also of note, this study was published just in time for the White House Antimicrobial Stewardship Forum!
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1 comment:

  1. Eli PerencevichJune 8, 2015 at 10:01 AM

    I agree - we definitely need more studies like this and Mike/Dick continue to guide us all with excellent editorials. Nice to move beyond partial lunar cycle durations. The one thing I wish these "boring" studies would add are pre/post treatment surveillance cultures for resistant pathogens. It is unclear to me if "shorter" duration is always associated with lower risk of MDRO acquisition. It is possible that longer or even double/triple coverage might be associated with lower resistance. I would like to see surveillance cultures included so we can eventually understand the epidemiology of resistance and move beyond the dogma of shorter always equals better or "narrow" is always better than broad-spectrum. And maybe the dogma is correct, I just want data to prove it. However, I do agree that reducing exposure does lead to lower CDI risk, which is excellent.

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