Short-Course Versus Long-Course Systemic Antibiotic Treatment for Uncomplicated Intravascular Catheter-Related Bloodstream Infections due to Gram-Negative Bacteria, Enterococci or Coagulase-Negative Staphylococci: A Systematic Review

Abstract

Introduction:The optimal duration of systemic antimicrobial treatment for catheter-related bloodstream infections (CRBSI) is unknown. In this systematic review, we aimed to assess the efficacy of short-course treatment for CRBSI due to Gram-negative bacteria, coagulase-negative staphylococci and enterococci. Methods: We systematically searched the electronic bibliographic databases MEDLINE, EMBASE and Cochrane Library for studies published before February 2021. All studies that investigated the duration of adequate systemic antibiotic treatment in adult patients with uncomplicated intravascular catheter infections due to Gram-negative bacteria, coagulase-negative staphylococci or enterococci were eligible for inclusion. Studies including concomitant treatment with antibiotic lock therapy were excluded. The primary outcomes were clinical failure/cure, mortality and microbiologic-confirmed relapse. Results: Seven retrospective cohort studies and one case-cohort study met the inclusion criteria. No randomized controlled studies met inclusion criteria. The quality of the included studies was low (n = 7) to moderate (n = 1). No significant differences were observed regarding mortality and microbiological relapse between short-course and long-course systemic antibiotic treatment in patients with CRBSI due to coagulase-negative staphylococci or Gram-negative bacteria. No association was found between mortality and treatment duration in the two studies assessing enterococcal CRBSI. Conclusion:The limited data available suggests that shorter systemic antibiotic treatment

Medically managed spontaneous bacterial peritonitis and bacteraemia associated with jugular catheter infection in a dog with tetanus

“…Considering the susceptibility profile of the MDR organism cultured, the dog was administered cefovecin before discharge, providing continued antimicrobial coverage up to 17 days after the SBP diagnosis. The optimal duration of treatment for complicated CRBSI is not known 59 …”

“…The optimal duration of treatment for complicated CRBSI is not known. 59 Implementation of CLABSI prevention bundles in human ICUs has been associated with reduced rates of BSI. 60,61 These bundles include actions such as monthly feedback of surveillance reports, infection prevention education and credentialing of junior medical staff, routine preparation of the skin with 0.5% chlorhexidine gluconate before CVC insertion, and dedicated medical staff for CVC placement.…”

Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors

“…There is no consensus regarding the length of antimicrobial therapy. However, a recent meta-analysis suggests that a short-course therapy (seven days) for gram-negative bacteria, seven days for enterococci, and three days for coagulase-negative staphylococci could be sufficient in uncomplicated CVC-related infection [157]. However, the authors conclude that shorter courses may not be appropriate for immunocompromised patients, and prospective studies are warranted [157].…”

“…However, a recent meta-analysis suggests that a short-course therapy (seven days) for gram-negative bacteria, seven days for enterococci, and three days for coagulase-negative staphylococci could be sufficient in uncomplicated CVC-related infection [157]. However, the authors conclude that shorter courses may not be appropriate for immunocompromised patients, and prospective studies are warranted [157]. In case of complications, including tunnel infection, port abscess, septic thrombosis, endocarditis, and osteomyelitis, the catheter must always be removed, and appropriate pathogen-directed antimicrobial therapy should be used [155].…”

Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

“…Conversely, for CR-BSIs caused by coagulase-negative staphylococci, a very short treatment of 3 days (or even antibiotic withdrawal) after catheter removal may be sufficient [80,81], highlighting the importance of individualising the treatment duration.…”