Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

Chotiprasitsakul, Darunee; Han, Jennifer H.; Cosgrove, Sara E.; Harris, Anthony D.; Lautenbach, Ebbing; Conley, Anna; Tolomeo, Pam; Wise, Jacqueleen; Tamma, Pranita D.

doi:10.1093/cid/cix767

Cited by 150 publications

(122 citation statements)

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“…5; 1,750 patients; RR ϭ 1.08; 95% CI, 0.69 to 1.67; I 2 ϭ 0%). The relapse rate was also similar between short-and long-course treatments in one study that assessed relapse at 30 days from the completion of treatment (1.2% versus 2.3%, respectively; RR ϭ 0.56; 95% CI, 0.19 to 1.64) (10).…”

Section: Figmentioning

confidence: 68%

“…assigned with 7 stars (10, 11) (4 for selection, 1 for comparability, and 2 for outcome [10]; 4 for selection and 3 for outcome [11]), 1 study was assigned with 8 stars (4 for selection, 1 for comparability, and 3 for outcome) (20), and another 1 was assigned with 5 stars (4 for selection and 1 for outcome) (21). The source of bacteremia in the included studies accounted for urinary tract (54.8%), biliary/gastrointestinal tract infection (13.8%), intra-abdominal (5%), primary/central venous catheter-related bacteremia (4.8%), pneumonia (3.6%), soft tissue infection (1.4%), and other/unknown sources.…”

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confidence: 99%

“…Studies included in the meta-analysis: treatment for <10 days versus >10 days. We pooled studies that assessed mortality at 30 days (10,19) and 90 days (11,19,20) counting from the completion of the antibiotic therapy. Pooling of the studies that assessed 30-day mortality showed that there was no statistically significant difference in all-cause mortality between short-and long-course treatments (7.5% versus 7.6%, respectively) ( Fig.…”

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confidence: 99%

“…4; 1,080 patients; RR ϭ 1.02; 95% CI, 0.96 to 1.08), and no statistical heterogeneity was detected in this analysis (I 2 ϭ 0%). Moreover, 4 of the studies provided data on relapse of bacteremia (10,11,19,20). Relapse was assessed within 30 days (10) or 90 days (11,FIG 2 Forest plot depicting the risk ratios of 30-day mortality among patients receiving antibiotic treatment for Յ10 days versus Ͼ10 days.…”

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confidence: 99%

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A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

Tansarli

Andreatos

Pliakos

et al. 2019

Antimicrob Agents Chemother

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The duration of antibiotic therapy for bacteremia due to Enterobacteriaceae is not well defined. We sought to evaluate the clinical outcomes with shorterversus longer-course treatment. We performed a systematic search of the PubMed and EMBASE databases through May 2018. Studies presenting comparative outcomes between patients receiving antibiotic treatment for Յ10 days ("short-course") and those treated for Ͼ10 days ("long-course") were considered eligible. Four retrospective cohort studies and one randomized controlled trial comprising 2,865 patients met the inclusion criteria. The short-and long-course antibiotic treatments did not differ in 30-day all-cause mortality (1,374 patients; risk ratio [RR] ϭ 0.99; 95% confidence interval [CI], 0.69 to 1.43), 90-day all-cause mortality (1,750 patients; RR ϭ 1.16; 95% CI, 0.81 to 1.66), clinical cure (1,080 patients; RR ϭ 1.02; 95% CI, 0.96 to 1.08), or relapse at 90 days (1,750 patients; RR ϭ 1.08; 95% CI, 0.69 to 1.67). In patients with bacteremia due to Enterobacteriaceae, the short-and long-course antibiotic treatments did not differ significantly in terms of clinical outcomes. Further welldesigned studies are needed before treatment for 10 days or less is adopted in clinical practice.

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confidence: 68%

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confidence: 99%

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confidence: 99%

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A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

Tansarli

Andreatos

Pliakos

et al. 2019

Antimicrob Agents Chemother

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“…For example, optimal duration of treatment for endocarditis caused by methicillin-susceptible S. aureus may be shorter than for that caused by MRSA [136]. Similarly, although 7-10 days of therapy is appropriate for treatment of uncomplicated gram-negative bacteremia in immunocompetent hosts [137,138], uncomplicated S. aureus bacteremia requires a longer course of therapy to effect cure [139][140][141], likely because of unrecognized seeding [142]. Integrity of host immunity may also affect clearance of infection, so antimicrobial therapy for infection in neutropenic pediatric patients with cancer is often continued until resolution of neutropenia [78].…”

Section: We Recommend Determining the Duration Of Antimicrobial Theramentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection

Hayden

Won

2018

JAMA

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Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

Abstract: Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.

Cited by 150 publications

References 18 publications

A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection

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