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Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections

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Abstract

Purpose

Optimal antimicrobial treatment duration for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined effectiveness of short (7–10 days) and long (>10 days) courses of antimicrobial therapy for uncomplicated Gram-negative BSI.

Methods

Hospitalized adults with uncomplicated Gram-negative BSI at Palmetto Health hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were identified. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine risk of treatment failure in the two groups.

Results

During the study period, 117 and 294 patients received short and long courses of antimicrobial therapy for uncomplicated Gram-negative BSI, respectively. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median duration of antimicrobial therapy was 8.5 and 13.3 days in the short and long treatment groups, respectively. After adjustment for the propensity to use a short course of therapy, risk of treatment failure was higher in patients receiving short compared to long courses of antimicrobial agents (HR 2.60, 95% CI: 1.20–5.53, p = 0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.83, 95% CI: 1.89–15.02, p = 0.004) and immune compromised status (HR 4.30, 95% CI: 1.57–10.80, p = 0.006). Definitive antimicrobial therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.33, 95% CI: 0.14–0.73, p = 0.006).

Conclusions

The current results support common clinical practice of 2 weeks of antimicrobial therapy for uncomplicated Gram-negative BSI.

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Acknowledgements

The authors thank the Palmetto Health Antimicrobial Stewardship and Support Team in South Carolina, USA for their help in facilitating the conduction of this study. The preliminary results of this study were presented in part at IDWeek annual meeting in October 26-30, 2016; New Orleans, LA, USA (Abstract # 59811). ANN and MNA have full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the analysis.

Funding

ANN received funding from the Medical Scholars Program 2016 of the Infectious Disease Society of America Education and Research Foundation. Funding source had no role in study design. The study had no other sources of funding.

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Authors and Affiliations

  1. University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC, 29203, USA

    Avery N. Nelson, Helmut Albrecht & Majdi N. Al-Hasan

  2. Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA

    Julie Ann Justo & P. Brandon Bookstaver

  3. Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA

    Julie Ann Justo, P. Brandon Bookstaver & Joseph Kohn

  4. Department of Medicine, Palmetto Health USC Medical Group, Columbia, SC, USA

    Helmut Albrecht & Majdi N. Al-Hasan

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  1. Avery N. Nelson
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  2. Julie Ann Justo
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  6. Majdi N. Al-Hasan
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Corresponding author

Correspondence to Majdi N. Al-Hasan.

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Conflict of interest

ANN, JAJ, JK and HA: No conflicts. PBB and MNA: Continuous medical education steering committee for Rockpointe Corporation, Columbia, MD, USA.

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Nelson, A.N., Justo, J.A., Bookstaver, P.B. et al. Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections. Infection 45, 613–620 (2017). https://doi.org/10.1007/s15010-017-1020-5

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  • DOI: https://doi.org/10.1007/s15010-017-1020-5

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