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 Background Bloodstream infections (BSI) continue to be a major cause of morbidity and mortality in the United States; thus, the correct choice of antibiotics for an appropriate duration is imperative. However, there are limited recommendations on adequate duration of treatment of bacteremia caused by Gram-negative organisms. Therefore, treating an infection for an adequate duration to prevent complications while preventing adverse effects from unnecessary antibiotic exposure remains a balancing act. This study aims to compare clinical outcomes between patients treated with a short (7–10 days) vs. long (11–20 days) course of antibiotics for uncomplicated gram-negative bacteremia. Methods This single-center retrospective cohort study evaluated adult patients admitted between January 2007 to October 2018 with a blood culture positive for gram-negative bacteria. Data came from the University of Kentucky Microbiological Laboratory and Center for Clinical and Translational Science (CCTS) Data Bank. Patients included must have received appropriate antibiotics for at least 7 days. Appropriate antibiotics were defined as those to which the organism is susceptible with day one of therapy as the first day of appropriate antibiotic therapy. Patients were excluded if they were treated with aminoglycoside monotherapy, had polymicrobial bacteremia, or if treated for longer than 20 days of therapy. Results A total of 466 patients were identified (208 in the short-course group and 258 in the long course group). Gender and ethnicity were similar across both groups. The patients in the long course group had more ICU admissions compared with the short-course group (52.7% vs. 43.3%, P = 0.0426), tended to be older (57 ± 16.7 vs. 53 ± 15.9 years, P = 0.0119), had a higher Charlson Comorbidity Index (5.7 ± 3.6 vs. 4.6 ± 3.6, P = 0.0009) and remained admitted to the hospital longer (23.2 ± 25.6 vs. 15.8 ± 17.5 days, P = 0.0002). However, patients treated with a long course had no difference in 30-day mortality compared with the short-course group (3.9% vs. 3.4%, P = 0.7701). Conclusion Patients with an uncomplicated gram-negative BSI treated with a short course (7–10 days) of antibiotics do not appear to have a significant difference in 30-day mortality compared with those patients treated with a long course (11–20 days). Disclosures All authors: No reported disclosures.

Download Full-text

Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0624-1 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Sarah Melissa Nørgaard ◽

Camilla Skaarup Jensen ◽

Josefine Aalestrup ◽

Christina M. J. E. Vandenbroucke-Grauls ◽

Mark G. J. de Boer ◽

...

Keyword(s):

Systematic Review ◽

Combination Therapy ◽

Antibiotic Treatment ◽

Clinical Success ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Infection Site ◽

Gram Negative ◽

Group 2 ◽

Group 1

Abstract Background Antimicrobial resistance is an increasingly serious threat to public health, and the increased occurrence of multidrug-resistant (MDR) bacteria is a concern in both high-income and low- and middle-income countries. The purpose of this systematic review was to identify and critically appraise current antimicrobial treatment options for infections with MDR Gram-negative bacteria. Methods A literature search for treatment of MDR extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa was conducted in MEDLINE in January 2019. Relevant studies published in English, German, and French that evaluated clinical success, microbiological success, and 30-day mortality outcomes were included. The population of interest was adult patients. Results Of 672 studies, 43 met the inclusion criteria. Carbapenems are the most common antibiotics used for the treatment of ESBL-producing Enterobacteriaceae. The clinical and microbiological success was similar for group 1 carbapenems (imipenem, meropenem, or doripenem), group 2 carbapenems (ertapenem), and non-carbapenem antibiotics. Mortality data were contradictory for group 1 carbapenems compared to group 2 carbapenems. The most common treatment option for A. baumannii and P. aeruginosa infections was intravenous colistin, regardless of infection site. Clinical success and mortality were similar in A. baumannii infections treated with colistin combination therapy vs. colistin monotherapy, whereas heterogeneous results were found with respect to microbiological success. Monotherapy and colistin combination therapy were used against P. aeruginosa with clinical and microbiological success (70–100%) depending on the infection site and severity, and the antibiotic used. Ceftazidime-avibactam therapy for ESBL-producing Enterobacteriaceae and P. aeruginosa showed good clinical success in one study. Conclusion We did not find robust evidence for antibiotic treatment of any infection with MDR Gram-negative bacteria, including ESBL-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa, that would lead to a firm recommendation for one specific antibiotic over another or for monotherapy over combination therapy. The choice of antibiotic treatment should be based on susceptibility testing balancing the expected clinical success rate against the risk of development of antibiotic resistance and the risk of severe side effects.

Download Full-text

A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-019-03545-8 ◽

2019 ◽

Vol 38 (5) ◽

pp. 977-983 ◽

Cited By ~ 2

Author(s):

Rafael San-Juan ◽

Iván Martínez-Redondo ◽

Mario Fernández-Ruiz ◽

María Ruiz-Ruigómez ◽

Laura Corbella ◽

...

Keyword(s):

Antibiotic Treatment ◽

Bloodstream Infections ◽

Coagulase Negative Staphylococci ◽

Short Course

Download Full-text

Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis

10.21203/rs.3.rs-106504/v1 ◽

2020 ◽

Author(s):

Yuting Li ◽

Juan Yang ◽

Hongmei Yang ◽

Jianxing Guo ◽

Dong Zhang

Keyword(s):

Systematic Review ◽

Antibiotic Treatment ◽

Primary Outcome ◽

Meta Analysis ◽

Source Control ◽

Short Course ◽

Significant Difference ◽

All Cause Mortality ◽

Secondary Outcomes ◽

Long Course

Abstract Objectives: The optimal duration of therapy for primary bloodstream infection (BSI) and BSI secondary to major organ system infections has been poorly defined. A systematic review and meta-analysis was performed to evaluate the impact of short (≤10 days)and long course(>10 days) of antibiotic treatment on clinical outcomes in patients with BSI.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving patients with BSI. All authors reported our primary outcome of all-cause mortality and clearly comparing short versus long course of antibiotic treatment with clinically relevant secondary outcomes(source control and relapse). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 3593 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=1.10; 95% CI, 0.82 to 1.48; P=0.52; Chi2=7.57; I2=34%) . Secondary outcomes demonstrated that there was no statistically significant difference in the source control(OR=0.82; 95% CI, 0.61 to 1.10; P=0.18; Chi2=2.68; I2=25%)and relapse(OR=1.20; 95%CI,0.71 to 2.01; P=0.49; Chi2=0.26; I2=0%) between two groups. Conclusions: Short course of antibiotic treatment is not associated with either an increased risk of mortality or an increased odds of relapse compared with longer antibiotic treatment course for BSI. Furthermore, short course of antibiotic therapy is non-inferior to long course in terms of source control. Further large-scale RCTs are still required to confirm these results.

Download Full-text

Changing aetiology of healthcare-associated bloodstream infections at three medical centres in Taiwan, 2000–2011

Epidemiology and Infection ◽

10.1017/s0950268813003166 ◽

2013 ◽

Vol 142 (10) ◽

pp. 2180-2185 ◽

Cited By ~ 10

Author(s):

C. C. LAI ◽

Y. H. CHEN ◽

S. H. LIN ◽

K. P. CHUNG ◽

W. H. SHENG ◽

...

Keyword(s):

Bloodstream Infections ◽

Significant Decline ◽

Surveillance Study ◽

Gram Negative Bacteria ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Gram Negative ◽

E Coli ◽

Healthcare Associated ◽

Gram Positive Cocci

SUMMARYThis multicentre surveillance study was conducted to investigate the trends in incidence and aetiology of healthcare-associated bloodstream infections (HCA-BSIs) in Taiwan. From 2000 to 2011 a total of 56 830 HCA-BSIs were recorded at three medical centres, and coagulase-negative staphylococci (CoNS) were the most common pathogens isolated (n = 9465, 16·7%), followed by E. coli (n = 7599, 13·4%). The incidence of all HCA-BSIs in each and all hospitals significantly increased over the study period owing to the increase of aerobic Gram-positive cocci and Enterobacteriaceae by 4·2% and 3·6%, respectively. Non-fermenting Gram-negative bacteria, Bacteroides spp. and Candida spp. also showed an increase but there was a significant decline in the numbers of methicillin-resistant S. aureus. In conclusion, the incidence of HCA-BSIs in Taiwan is significantly increasing, especially for Enterobacteriaceae and aerobic Gram-positive cocci.

Download Full-text

Thirty-day all-cause mortality among bloodstream infections caused by Gram-negative bacteria in England

10.26226/morressier.56d5ba32d462b80296c94b68 ◽

2016 ◽

Author(s):

Sarah Gerver

Keyword(s):

Bloodstream Infections ◽

Gram Negative Bacteria ◽

Gram Negative ◽

All Cause Mortality

Download Full-text

Should microbiological screening in neonates be applied for prediction and prevention of sepsis with gram-negative bacteria? A systematic review applying a new evidence-based medicine framework

10.26226/morressier.57fe118dd462b8028d890824 ◽

2016 ◽

Author(s):

Juliane Seidel

Keyword(s):

Systematic Review ◽

Evidence Based Medicine ◽

Evidence Based ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Prediction And Prevention ◽

Based Medicine ◽

New Evidence

Download Full-text

Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052785 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2785

Author(s):

Agnieszka Chmielarczyk ◽

Monika Pomorska-Wesołowska ◽

Dorota Romaniszyn ◽

Jadwiga Wójkowska-Mach

Keyword(s):

Bloodstream Infections ◽

Diagnostic Techniques ◽

Resistance Mechanisms ◽

Infection Prevention And Control ◽

The South ◽

Coagulase Negative Staphylococci ◽

Aminoglycoside Resistance ◽

Gram Negative ◽

Maldi Tof ◽

Carbapenem Resistant

Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. Patients and methods: Data on 4218 LC-BSIs were collected between 2016–2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. Results: Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. Conclusions: The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.

Download Full-text