A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

Abstract

The duration of antibiotic therapy for bacteremia due to Enterobacteriaceae is not well defined. We sought to evaluate the clinical outcomes with shorterversus longer-course treatment. We performed a systematic search of the PubMed and EMBASE databases through May 2018. Studies presenting comparative outcomes between patients receiving antibiotic treatment for Յ10 days ("short-course") and those treated for Ͼ10 days ("long-course") were considered eligible. Four retrospective cohort studies and one randomized controlled trial comprising 2,865 patients met the inclusion criteria. The short-and long-course antibiotic treatments did not differ in 30-day all-cause mortality (1,374 patients; risk ratio [RR] ϭ 0.99; 95% confidence interval [CI], 0.69 to 1.43), 90-day all-cause mortality (1,750 patients; RR ϭ 1.16; 95% CI, 0.81 to 1.66), clinical cure (1,080 patients; RR ϭ 1.02; 95% CI, 0.96 to 1.08), or relapse at 90 days (1,750 patients; RR ϭ 1.08; 95% CI, 0.69 to 1.67). In patients with bacteremia due to Enterobacteriaceae, the short-and long-course antibiotic treatments did not differ significantly in terms of clinical outcomes. Further welldesigned studies are needed before treatment for 10 days or less is adopted in clinical practice.

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

“…bloodstream infections (BSIs) [9][10][11][12][13][14][15][16][17][18][19]. However, at the present moment, the optimal duration of BSI treatment is controversial and yet to be defined.…”

“…The optimal duration of antibiotic therapy is unknown. Moreover, previous studies demonstrated that a 10-day course could be sufficient to optimally treat patients with BSIs [14][15][16][17][18][19]. Therefore, the aim of the present study was to determine whether active day 3 and day 10 re-evaluation of patients with Gram-positive or Gram-negative BSIs leads to a further reduction in the duration of antibiotic therapy and hospital stay.…”

“…However, at the present moment, the optimal duration of BSI treatment is controversial and yet to be defined. Despite Infectious Diseases Society of America (IDSA) guidelines for the management of intravascular catheter-related uncomplicated BSIs due to Gram-negative bacilli recommending 7-14 days of therapy, several studies have reported similar clinical outcomes for "short course" (≤10 days) and "long course" (>10 days) antibiotic treatments [14][15][16][17][18][19]. Moreover, with the exception of catheter-related BSIs due to coagulase-negative Staphylococci, data on short course treatment for Gram-positive BSIs are still lacking [20][21][22].…”

A Practical Approach to Clinical Antibiotic Stewardship in the ICU Patient with Severe Infection

“…3,20,22 Several studies however suggested that prolonged courses of antibiotics are still being prescribed. [104][105][106][107] The trend toward shorter antibiotic courses gained firm support by a landmark trial in patients with VAP, where a shorter course of 8 days of antibiotic treatment did not result in worse outcome. 108 Patients admitted to the ICU with severe abdominal infections could be managed successfully with a 7-day course of antibiotics.…”

“…70 Subsequently numerous other trials found that shorter courses of antibiotics were considered safe and effective in many types of infections, including community-acquired pneumonia, urinary tract infections, vertebral osteomyelitis, and even bloodstream infections. 104,[109][110][111][112] Most of these trials however do not separately describe the subset of septic shock and/or critically ill patients with multiple organ failure, so extrapolating these findings to the severely ill could be difficult.…”