Outcomes similar in people with gram-negative bacteremia despite antibiotic duration
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Key takeaways:
- Ninety-day risk of all-cause mortality was 11.2% and 9.9% for patients given a shorter or longer antibiotic duration, respectively.
- During follow-up, 30-day risk of all-cause mortality was 5.8% and 4.6%.
Study findings from hospitals in Copenhagen add to growing data that shorter antibiotic treatment duration is effective for patients with gram-negative bacteremia.
“What prompted this specific study was the need to find and investigate effective treatment strategies in the treatment of gram-negative bacteremia in order to address the current challenges of antibiotic overuse and emerging antibiotic resistance,” Sandra Tingsgård, MD, PhD-fellow at Copenhagen University Hospital’s Center of Research and Disruption of Infectious Diseases, told Healio.
“The motivation for the study was ability of the target trial emulation and the cloning approach to use real-life data from clinical settings to address the question of antibiotic treatment duration, while mitigating the risk of bias that observational studies are usually criticized for,” Tingsgård said.
The researchers used a hypothetical target trial that distributed individuals with gram-negative bacteremia at four hospitals in Copenhagen to either short antibiotic treatment duration of 5 to 7 days or longer antibiotic treatment duration of 8 to 14 days and assessed 90-day all-cause mortality between the groups.
In total, 1,040 people were included in the study, the majority of whom had community-acquired gram-negative bacteremia (86%), with UTI as the source of the infection (78%), and Escherichia coli as the pathogen of the infection (73%).
Study data showed that the adjusted 90-day risk of all-cause mortality was 11.2% (95% CI,
10.4-11.9) for patients receiving shorter treatment duration and 9.9% (95% CI, 8.2-12.3) for those receiving longer treatment duration (RR = 1.12; 95% CI, 0.89-1.37).
During the 30-day follow-up, the researchers found that 69 (6.6%) patients in the precloned dataset died, generating an adjusted 30-day risk of all-cause mortality of 5.8% (95% CI, 5.1-6.5) for those receiving short treatment duration and 4.6% (95% CI, 3.2-5.9) for patients receiving long treatment duration.
“For patients with rather uncomplicated gram-negative bacteremia, a short treatment duration may be just as effective as a longer duration,” Tingsgård said. “However, it is also important to emphasize that rather than one-size-fits-all, the results of this study contribute to understanding the nuanced factors influencing treatment outcomes, which emphasizes the need to tailor the approach of treatment duration to each individual based on their unique characteristics.”
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