Journal Review in Emergency General Surgery: STOP-IT - What a Decade of Data Has Taught Us

It’s postoperative day four after surgery for a perforated colon. The source appears controlled, but the patient is still intubated, the white count is eighteen, and nobody feels comfortable stopping piperacillin–tazobactam. Is four days really enough? Does the ICU buy another four—or is it time to ask what we’re missing?

Join Drs. Rushabh Dev, Skye Shultz, Kelly Ray, Desra Fletcher, and Brycen Ratcliffe from the Emergency General Surgery team in Tiger Country at Mizzou as they revisit STOP-IT and examine what more than a decade of evidence has added to the management of complicated intra-abdominal infection.

In this EGS Journal Review, the team appraises the landmark trial, explores its subgroup analyses and limitations, and puts contemporary SIS, IDSA, AAST, and Surviving Sepsis guidance into context. The discussion moves from source control and antibiotic duration to resistant organisms, cultures, de-escalation, ICU dosing, and the role of procalcitonin.

For most complicated intra-abdominal infections, approximately four days after adequate source control remains the default. Persistent illness should prompt a search for failed source control, ineffective therapy, or another diagnosis before simply extending the stop date.

Hosts

Dr. Rushabh Dev, MD, FACS – Moderator and Acute Care Surgeon, University of Missouri

Dr. Skye Shultz – Surgical Critical Care Fellow, University of Missouri

Dr. Kelly Ray – General Surgery Resident; STOP-IT appraisal and antimicrobial selection

Dr. Desra Fletcher – General Surgery Resident, University of Missouri; post-STOP-IT evidence and implementation

Dr. Brycen Ratcliffe – General Surgery Resident; society guidance and microbiology

Learning ObjectivesBy the end of this episode, listeners should be able to:

·       Describe the design, principal results, strengths, and limitations of STOP-IT, including why adequate source control is essential to applying its findings.