Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course vs Prolonged-Course Antibiotic Therapy

Abstract Background The recommended duration of antibiotic treatment for Enterobacteriaceae bacteremia is between 7 and 14 days. We compared the clinical outcomes of patients receiving short-course (6–10 days) vs prolonged-course (11–15 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at The Johns Hopkins Hospital, The University of Maryland Medical Center, and The Hospital of the University of Pennsylvania including patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active antibiotic therapy in the range of 6–15 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 for patients receiving short vs. prolonged durations of antibiotic therapy. Secondary outcomes included Clostridium difficile infection (CDI) and the emergence of multidrug-resistant Gram-negative (MDRGN) bacteria within 30 days after the end of antibiotic therapy. Results A total of 1,769 patients met eligibility criteria. There were 385 matched pairs who were well-balanced on baseline characteristics. 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 all-cause mortality between short- and prolonged-course treatment groups was observed (adjusted hazard ratio [aHR] 1.00; 95% CI 0.62–1.63). Rates of CDI were similar between the treatment groups (OR 1.17; 95% CI 0.39–3.51). There was a non-significant protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (OR 0.59; 95% CI 0.32–1.09 P = 0.09). Conclusion Short courses of antibiotic therapy yields similar clinical outcomes to prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN emergence. Disclosures All authors: No reported disclosures.

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212. Outcomes of Adults with Uncomplicated Staphylococcus aureus Bacteremia Receiving Short-Course Vs. Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.287 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S125-S126

Author(s):

Louise Thorlacius-Ussing ◽

Jette Nissen ◽

Jon J Rasmussen ◽

Robert Skov ◽

Magnus Arpi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Propensity Score ◽

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Nearest Neighbor ◽

Bloodstream Infections ◽

Staphylococcus Aureus Bacteremia ◽

Short Course ◽

Short Courses

Abstract Background The recommended duration of antibiotic treatment for uncomplicated Staphylococcus aureus bloodstream infections is 14 days. We compared the outcomes of patients receiving short-course (6–10 days) vs. prolonged-course (11–16 days) antibiotic therapy for S. aureus bacteremia (SAB). Methods 30-day outcome of patients with penicillin (PSSAB, n = 202)) or methicillin-susceptible SAB (MSSAB, n = 203) treated with in vitro active therapy in the range of 6–16 days was analyzed using pooled data from two previously published, observational studies. Individuals were matched 1:1 by nearest neighbor propensity score matching without replacement. Regression analysis was performed to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment. Eligible individuals had to have >1 day of follow-up after discontinuation of antimicrobials. Individuals with a diagnosis of endocarditis, bone infection, meningitis or pneumonia were excluded. Results There were 107 well-balanced matched pairs; 58 in the PSSAB and 39 in the MSSAB cohort. For PSSAB, the median duration of therapy was 8 (interquartile range [IQR], 7–10) in the short-course group and 12 days (IQR, 10–13) in the prolonged-course group. For the MSSAB cohort, these numbers were 9 days (IQR, 7–10) and 14 days (IQR, 13–16 days), respectively. No difference in mortality between short-course and prolonged-course treatment was observed (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], .23–2.41) and 1.14; 95% CI, 0.31–4.20), respectively for PSSAB and MSSAB. Conclusion Short courses of antibiotic therapy yielded similar clinical outcomes as prolonged courses of antibiotic therapy for S. aureus bacteremia. The findings warrant a randomized clinical trial to study the safety and efficacy of shortened antimicrobial therapy for the treatment of uncomplicated SAB. Disclosures All authors: No reported disclosures.

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195. Duration of Therapy for Streptococcal Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.397 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S205-S205

Author(s):

John M Boulos ◽

Valeria Fabre ◽

Kate Dzintars ◽

George Jones ◽

...

Keyword(s):

Antibiotic Therapy ◽

Clinical Outcomes ◽

Hospital Readmission ◽

Primary Outcome ◽

Bloodstream Infections ◽

Multivariable Logistic Regression Analysis ◽

Eligibility Criteria ◽

Short Course ◽

All Cause Mortality ◽

Long Course

Abstract Background Shorter durations have shown similar clinical outcomes as longer durations for uncomplicated (source-controlled) Gram-negative bloodstream infections (BSI). There is limited data on the outcomes of patients with non-pneumococcal streptococcal BSI receiving shorter durations of therapy compared to usual durations. Methods This was a retrospective, multicenter study of adults hospitalized between January 2018 and March 2019 with ≥ 1 blood culture positive for Streptococcus spp. Exposed patients were those who received ≤ 10 days of antibiotics (i.e., short course therapy) and unexposed patients were those who received 11-21 days of antibiotics (i.e., prolonged course therapy). Patients were excluded if they had S. pneumoniae BSI, suspected contamination, did not receive or complete therapy, or treated for > 21 days. The primary outcome was a composite of recurrent bacteremia with the same pathogen, hospital readmission, or all-cause mortality, all within 30 days from completing therapy. The odds of achieving the primary outcome was compared between exposed and unexposed patients using multivariable logistic regression analysis. Results A total of 176 patients met eligibility criteria. 35 (20%) received a short course (median 8 days) and 141 (80%) received a prolonged course (median 15 days) of antibiotic therapy. Baseline characteristics were similar between short and long course groups. The most common pathogens were viridans group streptococci (22%) and S. agalactiae (23%). The most common BSI source was skin and soft tissue infection (SSTI) (40%). The primary outcome occurred in 26% (9/35) and 23% (33/141) of patients in the short course and prolonged course groups, respectively (p = 0.774). The proportion of patients in the short course and prolonged course groups who experienced recurrent BSI, hospital readmission, or all-cause mortality were also non-significant. After adjusting for receipt of an infectious diseases consult, Pitt bacteremia score, and SSTI source, the adjusted odds of meeting the composite outcome remained unchanged (aOR 1.41, 95% CI 0.55 – 3.61, p = 0.466). Table 1. Cohort Characteristics Table 2. Source/Microbiology Table 3. Outcomes Conclusion Approximately a week of antibiotic therapy may be associated with similar clinical outcomes as longer antibiotics courses in patients with uncomplicated streptococcal BSI. Disclosures Kate Dzintars, PharmD, Nothing to disclose Sara E. Cosgrove, MD, MS, Basilea (Individual(s) Involved: Self): Consultant Pranita Tamma, MD, MHS, Nothing to disclose

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A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02495-18 ◽

2019 ◽

Vol 63 (5) ◽

Cited By ~ 6

Author(s):

Giannoula S. Tansarli ◽

Nikolaos Andreatos ◽

Elina E. Pliakos ◽

Eleftherios Mylonakis

Keyword(s):

Clinical Outcomes ◽

Antibiotic Treatment ◽

Controlled Trial ◽

Meta Analysis ◽

Content Type ◽

Randomized Controlled ◽

Short Course ◽

All Cause Mortality ◽

Retrospective Cohort Studies ◽

Long Course

ABSTRACT The duration of antibiotic therapy for bacteremia due to Enterobacteriaceae is not well defined. We sought to evaluate the clinical outcomes with shorter- versus longer-course treatment. We performed a systematic search of the PubMed and EMBASE databases through May 2018. Studies presenting comparative outcomes between patients receiving antibiotic treatment for ≤10 days (“short-course”) and those treated for >10 days (“long-course”) were considered eligible. Four retrospective cohort studies and one randomized controlled trial comprising 2,865 patients met the inclusion criteria. The short- and long-course antibiotic treatments did not differ in 30-day all-cause mortality (1,374 patients; risk ratio [RR] = 0.99; 95% confidence interval [CI], 0.69 to 1.43), 90-day all-cause mortality (1,750 patients; RR = 1.16; 95% CI, 0.81 to 1.66), clinical cure (1,080 patients; RR = 1.02; 95% CI, 0.96 to 1.08), or relapse at 90 days (1,750 patients; RR = 1.08; 95% CI, 0.69 to 1.67). In patients with bacteremia due to Enterobacteriaceae, the short- and long-course antibiotic treatments did not differ significantly in terms of clinical outcomes. Further well-designed studies are needed before treatment for 10 days or less is adopted in clinical practice.

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The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study

Archives of Plastic Surgery ◽

10.5999/aps.2021.00913 ◽

2021 ◽

Vol 48 (6) ◽

pp. 622-629

Author(s):

Yun Hyun Kim ◽

Jeong Yeop Ryu ◽

Joon Seok Lee ◽

Seok Jong Lee ◽

Jong Min Lee ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Group ◽

Clinical Outcomes ◽

Vascular Malformations ◽

Medical Center ◽

Surgical Excision ◽

Complication Rates ◽

Venous Malformations ◽

Treatment Groups ◽

Comparative Clinical Study

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

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The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa055 ◽

2020 ◽

Cited By ~ 2

Author(s):

Rebecca G Same ◽

Joe Amoah ◽

Alice J Hsu ◽

Adam L Hersh ◽

Daniel J Sklansky ◽

...

Keyword(s):

Antibiotic Therapy ◽

Treatment Failure ◽

Propensity Score Analysis ◽

Day Treatment ◽

Hospital Readmissions ◽

Community Acquired Pneumonia ◽

Emergency Department Visits ◽

Johns Hopkins Hospital ◽

National Guidelines ◽

Short Course

Abstract Background National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated. Methods We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5–7 days) vs prolonged-course (8–14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Children with tracheostomies; healthcare-associated, hospital-acquired, or ventilator-associated pneumonia; loculated or moderate to large pleural effusion or pulmonary abscess; intensive care unit stay >48 hours; cystic fibrosis/bronchiectasis; severe immunosuppression; or unusual pathogens were excluded. The primary outcome was treatment failure, a composite of unanticipated emergency department visits, outpatient visits, hospital readmissions, or death (all determined to be likely attributable to bacterial pneumonia) within 30 days after completing antibiotic therapy. Results Four hundred and thirty-nine patients met eligibility criteria; 168 (38%) patients received short-course therapy (median, 6 days) and 271 (62%) received prolonged-course therapy (median, 10 days). Four percent of children experienced treatment failure, with no differences observed between patients who received short-course vs prolonged-course antibiotic therapy (odds ratio, 0.48; 95% confidence interval, .18–1.30). Conclusions A short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP.

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Short- vs. Long-Course Antibiotic Treatment for Acute Streptococcal Pharyngitis: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Antibiotics ◽

10.3390/antibiotics9110733 ◽

2020 ◽

Vol 9 (11) ◽

pp. 733

Author(s):

Anna Engell Holm ◽

Carl Llor ◽

Lars Bjerrum ◽

Gloria Cordoba

Keyword(s):

Antibiotic Therapy ◽

Randomized Controlled Trials ◽

Antibiotic Treatment ◽

Clinical Cure ◽

Randomized Clinical Trials ◽

Streptococcal Pharyngitis ◽

Controlled Trials ◽

Randomized Controlled ◽

Short Course ◽

Long Course

BACKGROUND: To evaluate the effectiveness of short courses of antibiotic therapy for patients with acute streptococcal pharyngitis. METHODS: Randomized controlled trials comparing short-course antibiotic therapy (≤5 days) with long-course antibiotic therapy (≥7 days) for patients with streptococcal pharyngitis were included. Two primary outcomes: early clinical cure and early bacterial eradication. RESULTS: Fifty randomized clinical trials were included. Overall, short-course antibiotic treatment was as effective as long-course antibiotic treatment for early clinical cure (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.79 to 1.15). Subgroup analysis showed that short-course penicillin was less effective for early clinical cure (OR 0.43; 95% CI, 0.23 to 0.82) and bacteriological eradication (OR 0.34; 95% CI, 0.19 to 0.61) in comparison to long-course penicillin. Short-course macrolides were equally effective, compared to long-course penicillin. Finally, short-course cephalosporin was more effective for early clinical cure (OR 1.48; 95% CI, 1.11 to 1.96) and early microbiological cure (OR 1.60; 95% CI, 1.13 to 2.27) in comparison to long-course penicillin. In total, 1211 (17.7%) participants assigned to short-course antibiotic therapy, and 893 (12.3%) cases assigned to long-course, developed adverse events (OR 1.35; 95% CI, 1.08 to 1.68). CONCLUSIONS: Macrolides and cephalosporins belong to the list of “Highest Priority Critically Important Antimicrobials”; hence, long-course penicillin V should remain as the first line antibiotic for the management of patients with streptococcal pharyngitis as far as the benefits of using these two types of antibiotics do not outweigh the harms of their unnecessary use.

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Giant Cell Tumour of Bone with Late Presentation: Review of Treatment and Outcome

Journal of Orthopaedic Surgery ◽

10.1177/230949900201000204 ◽

2002 ◽

Vol 10 (2) ◽

pp. 120-128 ◽

Cited By ~ 18

Author(s):

ES Ng ◽

A Saw ◽

S Sengupta ◽

AR Nazarina ◽

M Path

Keyword(s):

Giant Cell ◽

Clinical Outcomes ◽

Giant Cell Tumour ◽

Medical Center ◽

Demographic Data ◽

Good Alternative ◽

Late Presentation ◽

Wide Excision ◽

Cell Tumour ◽

The University

Purpose. To review cases of giant cell tumour of bone or osteoclastoma managed at the University Malaya Medical Center, University of Malaya, Kuala Lumpur, from January 1990 to December 1999. Methods. Medical records of all patients with musculoskeletal tumours were reviewed. Demographic data, clinical presentation, surgical management, and clinical outcomes were reviewed retrospectively. Results. Most of the 31 patients who were treated for giant cell tumour of bone presented late on the basis of the duration of their symptoms and radiological features. Five of the patients had been referred for local recurrences. 26 patients were treated for primary tumours: 18 needed wide excision, 7 curettage, and one amputation. The joint could not be preserved and arthrodesis was performed for 11 patients. Three (12%) of the 26 patients had local recurrence during a mean follow-up of 60 months, including one (6%) who had recurrence after wide excision and 2 (29%) after curettage. Pulmonary metastasis was noted in 4 cases, 2 of which were confirmed histologically. Conclusion. Even in an advanced stage of disease, good clinical outcomes can be achieved with adequate excision and appropriate reconstruction. For lesions around the knee, autologous rotational grafting is a good alternative method of reconstruction.

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Short Course versus Standard Course Antibiotic Treatment for Neonatal Sepsis

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41071 ◽

2017 ◽

Vol 13 (1) ◽

pp. 124-127

Author(s):

Tahsinul Amin ◽

Ayesha Najma Nur

Keyword(s):

Clinical Outcome ◽

Antibiotic Therapy ◽

Hospital Stay ◽

Developmental Delay ◽

Antibiotic Treatment ◽

Neonatal Sepsis ◽

Group I ◽

Short Course ◽

Significant Difference ◽

Group Ii

Introduction: Neonatal sepsis remains an important cause of morbidity and mortality and often requires prompt empiric treatment. However, only a minority of babies who receive antibiotics for suspected sepsis have an infection. Antimicrobial exposure in infancy has important short-term and long-term consequences. There is no consensus regarding empirical antimicrobial regimens. Objective: To compare efficacy and benefits of short course (5 days) over the standard course (7 days) antibiotic treatment for neonatal sepsis. Materials and Methods: The study was a randomized controlled trial done in the neonatal ward in a tertiary level hospital comprising total 100 term neonates equally divided in to two groups by randomization where Group-I (5 days antibiotic therapy) was compared against Group-II (7 days antibiotic therapy) in clinical recovery, hospital stay, morbidity such as seizure, developmental delay etc and mortality. Results: The study results showed that both the Group-I and Group-II were comparable in baseline clinical data and predisposing factors; however, there was no significant difference between the two groups in clinical features e.g. hypotonia (24% vs 26%, p>0.05), poor primitive reflexes (46% vs 52%, p>0.05), temperature instability (34% vs 28%, p>0.05), feeding intolerance (16% vs 14%, p>0.05), apnea / respiratory distress (28% vs 34%, p>0.05) and in clinical outcome e.g. hospital stay (5.24±0.78 vs 7.86±0.42, p>0.05), recovery (86% vs 90%, p>0.05), death (14% vs 10%, p>0.05), seizure disorder (8% vs 6%, p>0.05) and developmental delay (6% vs 4%, p>0.05). Conclusion: This study showed that there was no significant difference between the study groups in clinical outcome, however, short course antibiotic (5 days) is equally effective but economically more beneficial to standard course antibiotic (7 days) therapy for neonatal sepsis. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 124-127

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Treatment of Asymptomatic Bacteriuria after Implementation of an Inpatient Urine Culture Algorithm in the Electronic Medical Record

Pharmacy ◽

10.3390/pharmacy9030138 ◽

2021 ◽

Vol 9 (3) ◽

pp. 138

Author(s):

Dianne Osiemo ◽

Danny K. Schroeder ◽

Donald G. Klepser ◽

Trevor C. Van Schooneveld ◽

Andrew B. Watkins ◽

...

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Asymptomatic Bacteriuria ◽

Provider Education ◽

Quasi Experimental ◽

Culture Algorithm ◽

Over Time

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB.

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