Antibiotic Treatment Duration for Bloodstream Infections in Critically Ill Patients

Abstract

Context: Antibiotic treatment duration for bloodstream infections (BSIs) is an area of controversy and uncertainty. Aims: Our objective was to assess antibiotic treatment duration practices for critically ill patients with BSIs in Kuwait. Subjects and Methods: A survey consisting of clinical scenarios followed by questions about recommended antibiotic treatment duration for each scenario was sent to Kuwaiti infectious diseases, critical care specialists, and anesthetists with critical care experience. Statistical Analysis Used: Descriptive analysis (medians and interquartile ranges) and Kruskal–Wallis test were used for statistical analysis. Results: The survey response rate was 68% (112/164). The median (interquartile range [IQR]) ranges for antibiotic duration recommendations were similar for each bacteremic syndrome: central line-associated BSIs, 10 days (7–14); pneumonia, 10 days (7–14); urinary tract infection, 10 days (7–14); intra-abdominal infection, 10 days (7–14); and skin and soft-tissue infection, 10 days (7–14). The median (IQR) antibiotic durations for the following bacteria were as follows: Staphylococcus aureus, 14 days (10–14); extended-spectrum beta-lactamase Escherichia coli, 10 days (7–14); multidrug-resistant (MDR) Pseudomonas aeruginosa, 14 days (10–14); MDR Acinetobacter baumannii, 14 days (10–14); vancomycin-resistant Enterococcus faecalis, 14 days (10–14); carbapenem-resistant Klebsiella pneumoniae, 14 days (10–14); and coagulase-negative Staphylococcus, 7 days (7–10). For all infectious syndromes and individual organisms, duration responses often followed discrete choices of 5, 7, 10, and 14 days. Prolonging antibiotic therapy for immunocompromised patients was favored among 70% of respondents. Conclusions: This survey demonstrates practice variation in treating BSIs and supports the need for adequately powered randomized controlled trials assessing optimal antibiotic duration for various bacteremic syndromes, pathogens, and resistance patterns.