Effect of Antibiotic Duration in Emergency General Surgery Patients with Intra-Abdominal Infection Managed with Open vs Closed Abdomen

Jose J. Diaz, Martin D. Zielinski, Amanda M. Chipman, Lindsay O'Meara, Thomas Schroeppel, Daniel Cullinane, Thomas Shoultz, Stephen L. Barnes, Addison K. May, Adrian A. Maung, Samuel Wade Ross, Addison K. May, Rachel M. Nygaard, Juan Mariscal, Jon Krook, Joseph V. Sakran, Eric W. Etchill, Lekha V. Yesantharao, Kaushik Mukherjee, Jordan BashamDaniel Cullinane, Martin D. Zielinski, Matthew C. Hernandez, Rebecca Zhu, Basil S. Karam, Marshall Beckman, Kosar Khwaja, Aasmine Kaur, Steven Briggs, Joao Rezende-Neto, Avi Bhavaraju, Matthew L. Roberts, Kyle J. Kalkwarf, Allison E. Berndtson, Todd W. Costantini, Thomas Schroeppel, Jessica K. Reynolds, Blake A. Stephens, Jose J. Diaz, Amanda M. Chipman, Lindsay O'Meara, Roumen Vesselinov, Joseph A. Kufera, Stephen L. Barnes, Alana Tucker, Lillian S. Kao, Shuyan Wei, Kayla Isbell, Thomas Shoultz, Casey Kohler, Robert G. Sawyer, Jesse Chou, Allison Zheng, Homer Stryker, Randy J. Woods, Adrian A. Maung, Bishwajit Bhattacharya

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND: Data on duration of antibiotics in patients managed with an open abdomen (OA) due to intra-abdominal infection (IAI) are scarce. We hypothesized that patients with IAI managed with OA rather than closed abdomen (CA) would have higher rates of secondary infections (SIs) independent of the duration of the antibiotic treatment. METHODS: This was an observational, prospective, multicenter, international study of patients with IAI requiring laparotomy for source control. Demographic and antibiotic duration values were collected. Primary outcomes were SI (surgical site, bloodstream, pneumonia, urinary tract) and mortality. Statistical analysis included ANOVA, chi-square/Fisher's exact test, and logistic regression. RESULTS: Twenty-one centers contributed 752 patients. The average age was 59.6 years, 43.6% were women, and 43.9% were managed with OA. Overall mortality was 16.1%, with higher rates among OA patients (31.6% vs 4.4%, p < 0.001). OA patients had higher Sequential Organ Failure Assessment (4.7 vs 1.8, p < 0.001), American Society of Anesthesiologists Physical Status (3.6 vs 2.7, p < 0.001), and APACHE II scores (16.1 vs 9.4, p < 0.001). The mean duration of antibiotics was 6.5 days (8.0 OA vs 5.4 CA, p < 0.001). A total of 179 (23.8%) patients developed SI (33.1% OA vs 16.8% CA, p < 0.001). Longer antibiotic duration was associated with increased rates of SI: 1 to 2 days, 15.8%; 3 to 5 days, 20.4%; 6 to 14 days, 26.6%; and more than 14 days, 46.8% (p < 0.001). CONCLUSIONS: Patients with IAI managed with OA had higher rates of SI and increased mortality compared with CA. A prolonged duration of antibiotics was associated with increased rates of SI. Increased antibiotic duration is not associated with improved outcomes in patients with IAI and OA.

Original languageEnglish (US)
Pages (from-to)419-427
Number of pages9
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Apr 1 2022

ASJC Scopus subject areas

  • General Medicine


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