Optimal duration of antibiotic treatment in Gram-negative infections

Abstract

Purpose of review Whilst many guidelines recommend limiting the use of antibiotics because of the increase in antimicrobial resistance (AMR), this strategy becomes challenging when dealing with severe infections in critically ill patients. Moreover, some Gram-negative bacilli (GNB) can exhibit mechanisms of resistance that make the patient more vulnerable to recurrence of infections. We reviewed recent data on the optimal duration of antibiotic therapy in these patients. Recent findings Apart from having no additional clinical benefit at a certain point after initiation, antibiotics might have negative effects. Prolonged antibiotic exposure has been associated to development of AMR and represents a strong reason to avoid long courses of antibiotic therapy in GNB infections. Recent data suggest that also patients with severe infections, in whom source control is adequate, can be managed with short-course antibiotic therapy. Summary The optimal duration of antibiotic therapy depends on many factors, but overall, many infections in the critically ill can be treated with short-course antibiotic therapy (7 days or less). The integration of signs of resolution, biomarkers, clinical judgment, and microbiologic eradication might help to define this optimal duration in patients with life-threatening infections caused by GNB.

Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

“…aeruginosa infection, and A . baumannii infection [ 13 ]. Therefore, the optimal duration of antimicrobial therapy for cancer patients with CRAB infection remains uncertain and needs to be investigated.…”

“…In some recent studies, the duration of antibiotic therapy for Acinetobacter baumannii infection was not well defined [ 10 , 11 , 12 , 13 , 14 ]. In previous studies, the definition typically used for short-course treatment was less than 10 days, while long-course treatment was typically defined as more than or equal to 10 days [ 15 , 16 , 17 ].…”

“…In the clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society (IDSA/ATS), a 7-day course of antimicrobial therapy was strongly recommended for hospital-acquired and ventilator-associated pneumonia rather than a longer duration, even in non-fermentative Gram-negative bacilli infection including P. aeruginosa and A. baumannii [ 19 ]. Remarkably, A. baumannii might be one of the most debated pathogens for antibiotic treatment duration; many clinicians usually consider continuation of antibiotic therapy for up to 2 weeks in many patients with established infection [ 10 , 11 , 12 , 13 , 14 ]. However, using antibiotics for 14 days was classified as a long treatment duration in many studies and guidelines [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…However, prior studies examining the impact of duration of antimicrobial therapy in cancer patients with CRAB infection remain limited. Most randomized controlled trials on duration of antibiotic therapy do not include difficult-to-treat patients or pathogens, such as immunocompromised patients, critically ill patients, specific infection foci, P. aeruginosa infection, and A. baumannii infection [13]. Therefore, the optimal duration of antimicrobial therapy for cancer patients with CRAB infection remains uncertain and needs to be investigated.…”

How I search for a sepsis source

“…Identifying the infection source in a sepsis patient is important [1] as it allows for better antibiotic choices, recognizes the need for ancillary treatment, and identifies the need for source control interventions [2, 3]. Searching for the source of infection cannot be disconnected from the other aspects of sepsis management [4].…”