Antibiotic treatment duration for bloodstream infections in critically ill patients: a national survey of Canadian infectious diseases and critical care specialists

Duration of Antimicrobial Treatment for Bacteremia in Canadian Critically Ill Patients*

“…Considering this gap in knowledge, our national survey of Canadian critical care and infectious diseases physicians demonstrated wide variation in reported durations of antimicrobial treatment for bacteremia (13). The most common duration reported was 14 days, and this was consistent among the five most common bacteremic syndromes: bacteremic pneumonia, bacteremic urinary tract infection, central venous catheterassociated bacteremia, bacteremic intra-abdominal infection, and bacteremic skin and soft-tissue infection.…”

“…Duplicate adjudication for duration of treatment in the first 100 cases was done by N.D. and a second blinded infectious diseases physician at the central study site; agreement between the two adjudicators was excellent (Spearman correlation coefficient = 0.96; intraclass correlation coefficient = 0.97) (26). Antimicrobial treatment duration was dichotomized as shorter (≤ 10 d) and longer (> 10 d) for most analyses; this cut-point was chosen based on the median treatment duration recommendations for bacteremia according to clinician respondents to a previous national practice survey (13).…”

“…The most common duration reported was 14 days, and this was consistent among the five most common bacteremic syndromes: bacteremic pneumonia, bacteremic urinary tract infection, central venous catheterassociated bacteremia, bacteremic intra-abdominal infection, and bacteremic skin and soft-tissue infection. However, at least half of respondents reported treatment durations that ranged from 7 to 10 days (13). Self-reported clinician behaviors and prescribing practices, though, do not necessarily reflect actual clinical practice (14)(15)(16).…”

Staphylococcus aureus Bacteremia in Adults

“…Though no specific guidelines exist regarding duration of treatment, the general consensus advocates a 14-day treatment course for S. aureus bacteremia in cases where the source such as an intravascular catheter or prosthetic device can be removed, or an abscess can be drained [11]. In cases where removal of an intravascular catheter is not possible, antibiotic lock therapy may be used in an attempt to salvage the line, which includes filling the catheter lumen with high concentrations of antibiotics and leaving them in place for several hours to days [12].…”

Pathogens and antimicrobial susceptibility profiles in critically ill patients with bloodstream infections: a descriptive study

“…4,24 Hypothesized hospital-level factors contributing to variation in highly resistant microorganisms include differing infection prevention and control practices, antimicrobial use practices, hospital size, staffing (nurse ratios, infection prevention and/or hospital epidemiology staffing) and characteristics of the patient populations served. [25][26][27][28] All sites that contributed data to this study were located within academic/teaching hospitals, which suggests that the variability was not due to hospital teaching status. Rates of highly resistant microorganisms were lowest in Manitoba and Quebec (5% each) and highest in Alberta, British Columbia and Ontario (20%, 16% and 15%, respectively).…”