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Purpose Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown. Methods A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up. Results Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041). Conclusion Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. Clinicaltrials.gov identifier NCT01311765., Author(s): Philippe Montravers [sup.1] [sup.18], Florence Tubach [sup.2], Thomas Lescot [sup.3], Benoit Veber [sup.4], Marina Esposito-Farèse [sup.5], Philippe Seguin [sup.6], Catherine Paugam [sup.7], Alain Lepape [sup.8], Claude Meistelman [sup.9], Joel [...]

Purpose To test whether the polymyxin B hemoperfusion (PMX HP) fiber column reduces mortality and organ failure in peritonitis-induced septic shock (SS) from abdominal infections. Method Prospective, multicenter, randomized controlled trial in 18 French intensive care units from October 2010 to March 2013, enrolling 243 patients with SS within 12 h after emergency surgery for peritonitis related to organ perforation. The PMX HP group received conventional therapy plus two sessions of PMX HP. Primary outcome was mortality on day 28; secondary outcomes were mortality on day 90 and a reduction in the severity of organ failures based on Sequential Organ Failure Assessment (SOFA) scores. Results Primary outcome: day 28 mortality in the PMX HP group (n = 119) was 27.7 versus 19.5 % in the conventional group (n = 113), p = 0.14 (OR 1.5872, 95 % CI 0.8583-2.935). Secondary endpoints: mortality rate at day 90 was 33.6 % in PMX-HP versus 24 % in conventional groups, p = 0.10 (OR 1.6128, 95 % CI 0.9067-2.8685); reduction in SOFA score from day 0 to day 7 was -5 (-11 to 6) in PMX-HP versus -5 (-11 to 9), p = 0.78. Comparable results were observed in the predefined subgroups (presence of comorbidity; adequacy of surgery, Conclusion This multicenter randomized controlled study demonstrated a non-significant increase in mortality and no improvement in organ failure with PMX HP treatment compared to conventional treatment of peritonitis-induced SS., Author(s): Didier M. Payen [sup.1] [sup.2], Joelle Guilhot [sup.3], Yoann Launey [sup.4], Anne Claire Lukaszewicz [sup.1] [sup.2], Mahmoud Kaaki [sup.5], Benoit Veber [sup.6], Julien Pottecher [sup.7], Olivier Joannes-Boyau [sup.8], Laurent [...]

Abstract Objective: to evaluate the ability of a surgical intensive care unit (SICU) medical staff to assess at admission the individual risk of nosocomial infection (NI) during SICU stay in [...]

Byline: Herve Dupont (1), Philippe Montravers (2), Remy Gauzit (2), Benoit Veber (3), Jean-Louis Pouriat (4), Claude Martin (5) Keywords: Postoperative pneumonia Mortality Antibiotic therapy Abstract: Objectives. Prognosis factors of ventilator-associated pneumonia (VAP) have been largely investigated, while the data concerning postoperative pneumonia (POP) are scarce. The aim of this multicenter, prospective study was to evaluate the predictive factors of mortality due to POP and the impact of initial antibiotic therapy on outcome. Methods. Two hundred centers were included. Diagnosis of POP was assessed on clinical and laboratory criteria, chest X-ray changes and microbiological criteria, when possible. Outcomes of the patients were noted. An independent committee made a retrospective assessment of appropriateness of antimicrobial therapy. Results. The overall mortality among the 556 cases of POP was 23% (126 patients). Five parameters were independently associated with mortality: American Society of Anesthesiology (ASA) grade 3 or more (p Conclusions. Five independent predictive factors for mortality of POP were identified. Despite a trend toward decreased mortality with appropriate initial antimicrobial therapy, no difference was observed between the groups. Polymicrobial pneumonia or non-fermenting Gram-negative bacilli appeared to be a risk factor for inappropriate AB. Author Affiliation: (1) Anesthesie-Reanimation Chirurgicale, CHU Bichat-Claude Bernard, APHP , 46 rue Henri Huchard, 75877, Paris Cedex 18, France (2) Anesthesie-Reanimation Chirurgicale, CHU Jean Verdier, APHP, Avenue du 14 Juillet, 93140, Bondy, France (3) Anesthesie-Reanimation Chirurgicale, CHU Charles Nicolle, 1 Rue Germont, 76000, Rouen, France (4) Urgences Medico-chirurgicales, CHU Hotel Dieu, APHP, 1 Place du Parvis Notre Dame, 75004, Paris, France (5) Anesthesie-Reanimation Chirurgicale, CHU Hopital nord, Chemin Bourrely, 13015, Marseille, France Article History: Received Date: 08/01/2002 Accepted Date: 07/11/2002 Article note: Electronic Publication