2020
DOI: 10.1001/jama.2020.6348
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Effect of C-Reactive Protein–Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia

Abstract: IMPORTANCE Antibiotic overuse drives antibiotic resistance. Gram-negative bacteremia is a common infection that results in substantial antibiotic use.OBJECTIVE To compare the clinical effectiveness of C-reactive protein (CRP)-guided, 7-day, and 14-day antibiotic durations 30, 60, and 90 days after treatment initiation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, noninferiority, point-of-care randomized clinical trial including adults hospitalized with gram-negative bacteremia conducted in 3 Swiss tertiary c… Show more

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Cited by 168 publications
(146 citation statements)
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References 21 publications
(41 reference statements)
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“… 47 Another important consideration is that the shortest effective treatment duration is unknown, as durations shorter than 7 days have not been systematically studied, to our knowledge. 27 , 28 Therefore, we may have overestimated the association of oral antibiotics with outcomes because it is plausible that some patients were adequately treated before initiating oral step-down therapy. 27 , 28 Given these considerations, a better understanding of patient factors associated with recurrence is important, as patient-specific factors, rather than definitive antibiotic selection or route, may be the primary factors associated with suboptimal outcomes.…”
Section: Discussionmentioning
confidence: 99%
“… 47 Another important consideration is that the shortest effective treatment duration is unknown, as durations shorter than 7 days have not been systematically studied, to our knowledge. 27 , 28 Therefore, we may have overestimated the association of oral antibiotics with outcomes because it is plausible that some patients were adequately treated before initiating oral step-down therapy. 27 , 28 Given these considerations, a better understanding of patient factors associated with recurrence is important, as patient-specific factors, rather than definitive antibiotic selection or route, may be the primary factors associated with suboptimal outcomes.…”
Section: Discussionmentioning
confidence: 99%
“…However, limitations of result interpretation exist due to a large non-inferiority margin, low event rate, wide range of treatment duration in the CRP group (median 7 days), and low adherence rate. Although not centered on ICU admissions, findings reinforce that the patient's response, instead of predetermined fixed duration AMT regimens, should guide ASP decisions [61].…”
Section: Assessment Of Treatment Response and Impact On Duration Of Amentioning
confidence: 88%
“…LC-MS data were measured with Thermo Scienti c ISQ QD. 1 HNMR and 13 CNMR were recorded on a Bruker Avance II 500 spectrometer in CDCl 3 unless stated otherwise, using tetramethylsilane as an internal reference, operated at 500.13 MHz for 1…”
Section: Analytic Methodsmentioning
confidence: 99%