Infectious Diseases I

iii.

Anti-enterococcal therapy should be considered in patients with recent exposure to broad-

spectrum antimicrobial therapy, septic shock, postoperative infections, and those documented

colonization with enterococci.

iv.

Anti-MRSA therapy should be considered in patients known to be colonized with MRSA or

with MDRO risk factors, including advanced age, co-morbid medical conditions, previous

hospitalization or surgery, and significant recent exposure to antibiotic agents.

Antifungal therapy should be added to the regimen of patients with yeast on Gram stain, recent

evidence of heavy colonization, surgically treated pancreatitis, prolonged broad-spectrum

antibiotic therapy, or critically ill patients with an upper gastrointestinal source. Fluconazole

is the drug of choice for fluconazole-susceptible strains. Echinocandins should be used first

line in critically ill patients until final culture results are available.

vi.

Empiric antimicrobial therapy should be de-escalated to final culture results and related

antimicrobial susceptibilities.

New guidance from the SIS regarding the duration of antimicrobial therapy in patients with intra-

abdominal infections (Surg Infect (Larchmt). 2024;25(6):419-435):

The authors recommend limiting antimicrobial therapy to 4 days after achieving source control,

given the results of the STOP-IT trial (N Engl J Med. 2015;372(21):1996-2005), including patients at

high risk with sepsis, or those at increased risk of complications from diabetes, obesity, or higher-

severity illness (grade 1-B recommendations).

The authors go on to recommend limiting antimicrobial therapy to 8 days in critically ill patients

after achieving source control of intra-abdominal infections (grade 2-B).

This recommendation came from the limited data of critically ill patients included in the STOP-

IT as well as other studies.

ii.

This recommendation is based on a single open-label randomized controlled trial, a systematic

review meta-analysis, and a retrospective cohort trial that compared durations of 8 vs 15 days

or 5 vs 10 days.

Considerations for short-term prophylactic courses no longer than 24 hours include:

Acute gastric or jejunal perforation in absence of malignancy or acid-reducing pharmacotherapy

with adequate source control within 24 hours

Traumatic or iatrogenic bowel injuries repaired within 12 hours of injury

Acute appendicitis without perforation or abscess