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

March 17, 2018 at 5:29 pm

Clinical Infectious Diseases January 6, 2018 V.66 N.2 P.172-177.

Chotiprasitsakul D1, Han JH2, Cosgrove SE3, Harris AD4, Lautenbach E2, Conley AT5, Tolomeo P2, Wise J2, Tamma PD6; Antibacterial Resistance Leadership Group.

Author information

1 Department of Medicine, Division of Infectious Diseases, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

2 Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia.

3 Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

4 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.

5 Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

6 Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Abstract

BACKGROUND:

The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia.

METHODS:

A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy.

RESULTS:

There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], .62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI, .32-1.09; P = .09).

CONCLUSIONS:

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.

FULL TEXT

https://academic.oup.com/cid/article/66/2/172/4371445

PDF (CLIC EN PDF)

Advertisements

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, F.O.D, Health Care-Associated Infections, Infecciones nosocomiales, Metodos diagnosticos, REPORTS, Resistencia bacteriana, Sepsis, Update.

Fatal Yellow Fever in Travelers to Brazil, 2018 Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis.


Calendar

March 2018
M T W T F S S
« Feb   Apr »
 1234
567891011
12131415161718
19202122232425
262728293031  

Most Recent Posts


%d bloggers like this: