LAUSR

Dear Editor, We read with great interest the paper presenting the results of the DURAPOP randomized clinical trial comparing the efficacy and safety of 8 days versus 15 days antibiotic therapy in critically ill patients with postoperative intra-abdominal infections (PIAI). The authors concluded that an 8-day antibiotic regimen reduced antibiotic exposure in ICU patients with proven PIAI without affecting outcome [1]. As the authors assessed, data about the optimal duration of antibiotic therapy for complicated intra-abdominal infections in ICU patients are lacking. In less severe patients with mild-to-moderate intra-abdominal infections, an even shorter course of 4 days has been shown to be as effective as longer treatments [2]. Our team conducted a study to evaluate the efficacy of a procalcitonin (PCT)-guided antibiotic therapy in critically ill patients with secondary peritonitis, of whom approximately 40% had nosocomial peritonitis (mostly postoperative) [3]. Duration of treatment in the PCTguided group was significantly shorter than in the nonPCT-guided group (5.1 ± 2.1 vs 10.2 ± 3.7 days) without affecting outcome. The severity of our patients, with a mean SAPS II of 43.4 ± 15.8 was comparable to that one reported by Montravers et al. [1], with a median SAPS II of 45 [IQR 34–51.8]. Our study suggests that antibiotic therapy duration may be shorter than the 8 days antibiotic regimen proposed by Montravers et al. [1] after adequate source control surgery. Very short treatments, of 4–5 days, may be safe by using PCT guidance, even in critically ill patients with proven PIAI. Shortening the antibiotic duration might reduce the emergence of multidrug-resistant bacteria in antimicrobial stewardship programs.