Short- versus long-course therapy in gram-negative bacilli bloodstream infections

Sousa, Adrián; Pérez-Rodríguez, M. Teresa; Suárez, Milagros; Val, Nuria; Martínez-Lamas, Lucía; Nodar, Andrés; Longueira, Rebeca; Crespo, Manuel

doi:10.1007/s10096-019-03467-5

Cited by 37 publications

(42 citation statements)

References 23 publications

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“…41 Recent data have suggested that 7 to 10 days of therapy are appropriate for the treatment of uncomplicated GNB bacteremia with early source control, including those caused by PSA. [103][104][105][106][107][108] In one recent study, the median treatment duration of 9 days was found to have similar odds of recurrent infection or death within 30 days as those who received longer courses (median 16 days, interquartile range 14-17). 106 Achievement of clinical response and source control remain important clinical considerations to help guide duration of treatment.…”

Section: Duration Of Treatment Of Mdr-psamentioning

confidence: 98%

Approach to the Treatment of Patients with Serious Multidrug‐Resistant Pseudomonas aeruginosa Infections

2020

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Multidrug resistance(MDR) among Pseudomonas aeruginosa (PSA) isolates presents a significant clinical challenge and can substantially complicate the approach to selection of optimal antibiotic therapy. This review addresses major considerations in antibiotic selection for patients with suspected or documented serious MDR‐PSA infections. Common mechanisms contributing to MDR among clinical PSA isolates are summarized. Empiric and definitive therapy considerations are addressed including the potential role of combination therapy. Newer agents with in vitro activity against MDR‐PSA (e.g., ceftolozane‐tazobactam, ceftazidime‐avibactam, imipenem‐relebactam, and cefiderocol) and their potential roles in clinical settings are discussed. Although these newer agents are promising options for the treatment of MDR‐PSA, clinical data remain generally limited. Future studies are needed to determine optimal agents for the empiric and definitive treatment of MDR‐PSA.

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Section: Duration Of Treatment Of Mdr-psamentioning

confidence: 98%

Approach to the Treatment of Patients with Serious Multidrug‐Resistant Pseudomonas aeruginosa Infections

2020

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 92%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of microbial BSI confirmation. In the pre-intervention phase (August 2014–August 2015), clinical status and antibiotic regimen were re-evaluated at day 3. In the intervention phase (January 2016–January 2017), clinical status and antibiotic regimen were re-evaluated at day 3 and day 10. Primary outcomes were rate of optimal therapy, duration of antibiotic therapy, length of hospitalization, and 30-day mortality. A total of 632 patients were enrolled (pre-intervention period, n = 303; intervention period, n = 329). Average duration of therapy reduced from 18.1 days (standard deviation (SD), 11.4) in the pre-intervention period to 16.8 days (SD, 12.7) in the intervention period (p < 0.001). Similarly, average length of hospitalization decreased from 24.1 days (SD, 20.8) to 20.6 days (SD, 17.7) (p = 0.001). No inter-group difference was found for the rate of 30-day mortality. In patients with BSI, re-evaluation of clinical status and antibiotic regimen at day 3 and 10 after microbiological diagnosis was correlated with a reduction in the duration of antibiotic therapy and hospital stay. The intervention is simple and has a low impact on overall costs.

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“…The search strategy identi ed 1269 studies, and the data were from six cohort studies comprising 3593 patients (Table 2) [12][13][14][15][16][17]. The characteristics of the included studies are shown in Table 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis

Li¹,

Yang²,

Yang³

et al. 2020

Preprint

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Objectives: The optimal duration of therapy for primary bloodstream infection (BSI) and BSI secondary to major organ system infections has been poorly defined. A systematic review and meta-analysis was performed to evaluate the impact of short (≤10 days)and long course(>10 days) of antibiotic treatment on clinical outcomes in patients with BSI.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving patients with BSI. All authors reported our primary outcome of all-cause mortality and clearly comparing short versus long course of antibiotic treatment with clinically relevant secondary outcomes(source control and relapse). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 3593 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=1.10; 95% CI, 0.82 to 1.48; P=0.52; Chi2=7.57; I2=34%) . Secondary outcomes demonstrated that there was no statistically significant difference in the source control(OR=0.82; 95% CI, 0.61 to 1.10; P=0.18; Chi2=2.68; I2=25%)and relapse(OR=1.20; 95%CI,0.71 to 2.01; P=0.49; Chi2=0.26; I2=0%) between two groups. Conclusions: Short course of antibiotic treatment is not associated with either an increased risk of mortality or an increased odds of relapse compared with longer antibiotic treatment course for BSI. Furthermore, short course of antibiotic therapy is non-inferior to long course in terms of source control. Further large-scale RCTs are still required to confirm these results.

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Short- versus long-course therapy in gram-negative bacilli bloodstream infections

Cited by 37 publications

References 23 publications

Approach to the Treatment of Patients with Serious Multidrug‐Resistant Pseudomonas aeruginosa Infections

Approach to the Treatment of Patients with Serious Multidrug‐Resistant Pseudomonas aeruginosa Infections

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

Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis

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