Observational versus randomized controlled trials to inform antibiotic treatment durations: a narrative review

McDonald, Emily G.; Prosty, Connor; Hanula, Ryan; NClin, Émilie Bortolussi-Courval; Albuquerque, Arthur M.; Tong, Steven Y C; Hamilton, Fergus; Lee, Todd C.

doi:10.1016/j.cmi.2022.09.002

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Fourth, knowledge of an ongoing intervention may have led to the Hawthorne effect. 45 Nonetheless, nonresearch deprescribing implementation efforts also benefit from clinical champions, as do audit and feedback interventions. Finally, this study was not powered to measure an effect on ADEs, emergency department visits, or hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Bortolussi-Courval,

Podymow,

Battistella

et al. 2024

Kidney Medicine

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Section: Discussionmentioning

confidence: 99%

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Bortolussi-Courval,

Podymow,

Battistella

et al. 2024

Kidney Medicine

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“…Nevertheless, all patients had confirmed BSI, which assures that patients had clinically relevant infections. Second, this type of study has two main possible sources of bias, which are indication and survival bias [ 20 ]. In the first case, longer courses of therapy may be chosen for patients with more severe diseases, whereas ending therapy within 7 days is most probable in patients with a favourable clinical response [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, this type of study has two main possible sources of bias, which are indication and survival bias [ 20 ]. In the first case, longer courses of therapy may be chosen for patients with more severe diseases, whereas ending therapy within 7 days is most probable in patients with a favourable clinical response [ 20 ]. We tried to minimize the risk of indication bias by evaluating distinct factors related to disease severity and controlling it in the multivariate model.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in univariate analysis, patients in long-term therapy groups had more severe disease at baseline; however, no difference in mortality was found in the multivariate model when adjusting for Pitt bacteraemia score, Charlson Comorbidity Index score, and carbapenem resistance. In the second case, survival bias, it is possible that some patients received longer courses of therapy because they lived longer and not the other way around [ 20 ]. To overcome survival bias, we only analysed patients who were alive on the 8th day after the beginning of active therapy.…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Therapy Duration for Bloodstream Infections Caused by Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex: A Retrospective Cohort Study

et al. 2023

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Background: Ideal therapy duration for Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex (ABC) bloodstream infections (BSI) is not defined, especially in the context of carbapenem resistance. In this study, we compared short- (≤7 days) and long-term (>7 days) antimicrobial therapy duration for these infections. Methods: We performed a retrospective cohort study in two tertiary-care hospitals in Porto Alegre, Brazil, from 2013 to 2019. Eligible patients aged ≥18 years were included and excluded for the following criteria: polymicrobial infections, treatment with non-susceptible antibiotics, complicated infections, or early mortality (<8 days of active antimicrobial therapy). The 30-day mortality risk was evaluated using a Cox regression model. Results: We included 237 BSI episodes, 51.5% caused by ABC and 48.5% by Pseudomonas aeruginosa. Short-term therapy was not associated with 30-day mortality, adjusted hazard ratio 1.01, 95% confidence interval 0.47–2.20, p = 0.98, when adjusted for Pitt score (p = 0.02), Charlson Comorbidity Index score (p < 0.01), and carbapenem resistance (p < 0.01). Among patients who survived, short-term therapy was associated with shorter hospital stay (p < 0.01). Results were maintained in the subgroups of BSI caused by carbapenem-resistant bacteria (p = 0.76), ABC (p = 0.61), and Pseudomonas aeruginosa (p = 0.39). Conclusions: Long-term therapies for non-complicated Pseudomonas aeruginosa and ABC BSI were not superior to short-term therapy for 30-day mortality.

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“…Although our intention was to better evaluate the indicators and avoid immortal time bias, this also made our study results not generalizable to all hematological malignancy patients. Second, there was randomness in the timing of repeating blood cultures after initiating targeted antibiotic therapy by the physicians in our study, which is a problem faced by many studies [ 22 ], as it is impossible to achieve fixed-time re-examination assembled in clinical trials. This may lead to bias in decision making of antibiotic duration.…”

Section: Discussionmentioning

confidence: 99%

Is Short-Course Antibiotic Therapy Suitable for Pseudomonas aeruginosa Bloodstream Infections in Onco-hematology Patients With Febrile Neutropenia? Results of a Multi-institutional Analysis

Feng,

Qian,

Fan

et al. 2023

Clinical Infectious Diseases

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Background Several studies have suggested that short-course antibiotic therapy was effective in Pseudomonas aeruginosa (PA) bloodstream infections (BSI) in immunocompetent patients. While similar studies in patients with hematological malignancies were rare. Methods This cohort study included onco-hematology patients at two hematology centers in China. Inverse probability of treatment weighting was used to balance the confounding factors. Multivariate regression model was used to evaluate the effect of short-course antibiotic therapy on clinical outcomes. Results 434 patients met eligibility criteria (short-course, 7-11 days, n=229; prolonged, 12-21 days, n=205). In the weighted cohort, the univariate and multivariate analysis indicated that short course antibiotic therapy had similar outcomes to the prolonged course. The recurrent PA infection at any site or mortality within 30 days of completing therapy occurred in 8 (3.9%) patients in the short-course group and in 10 (4.9%) in the prolonged-course group (p = 0.979). The recurrent infection within 90 days occurred in 20 (9.8%) patients in the short-course group and in 13 (6.3%) patients in the prolonged-course group (p =0.139), and the recurrent fever within 7 days occurred in 17 (8.3%) patients in the short-course group and in 15 (7.4%) in the prolonged-course group (p = 0.957). On average, patients who received short-course antibiotic therapy spent 3.3 fewer days in the hospital (p<0.001). Conclusions In the study, short-course therapy was non-inferior to prolonged-course therapy in terms of clinical outcomes. However, due to its biases and limitations, further prospective randomized controlled trials are needed to generalize our findings.

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Observational versus randomized controlled trials to inform antibiotic treatment durations: a narrative review

Cited by 9 publications

References 29 publications

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Antimicrobial Therapy Duration for Bloodstream Infections Caused by Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex: A Retrospective Cohort Study

Is Short-Course Antibiotic Therapy Suitable for Pseudomonas aeruginosa Bloodstream Infections in Onco-hematology Patients With Febrile Neutropenia? Results of a Multi-institutional Analysis

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