Antibiotic Course for Bloodstream Infections Can Safely Be Reduced by Half the Time
At ID Week 2024, in a late-breaking presentation, investigators are reporting it is safe to cut the antibiotic regimen in half without endangering patients for these infections.
Image Credit: Enginakyurt, Pexels
Concerns around bloodstream infections include significant morbidity and mortality. According to the World Health Organization (WHO), people who receive treatments through catheters often are particularly vulnerable to these types of infections, as they might be seriously ill or have low immunity. WHO estimated that between 2000–2018, average mortality among patients affected by health care-associated sepsis was 24.4%, increasing to 52.3% among patients treated in intensive care units.1
Many bloodstream infections are caused by antibiotic resistant bacterial infections. It is estimated that bacterial antimicrobial resistance (AMR) was directly responsible for at least 1.27 million deaths and contributed to an additional 4.95 million deaths in 2019.1
“Infections associated with health care delivery represent a preventable tragedy and a serious threat to the quality and safety of health care.” said Dr Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage, Life Course. “Implementing clean care and infection prevention and control recommendations is critical to saving lives and alleviating a great deal of avoidable suffering experienced by people around the world.”1
As there is an awareness around AMR and the severity of these infections, clinicians want to dose early with the appropriate antibiotic therapy, but finding the optimal duration of treatment has been undetermined.
However, new findings being presented at ID Week 2024, offer a new study with evidence of the appropriate dosing regimen. Specifically, investigators found seven-day course of antibiotics for hospitalized patients with bloodstream infections is just as effective as a 14-day course.
“Finding strong evidence that supports shorter antibiotic treatment durations is a top priority to advance antimicrobial stewardship as drug-resistant bacteria are increasingly becoming a public health threat,” said Nick Daneman, MD, clinician scientist in the Division of Infectious Diseases at Sunnybrook Health Sciences Centre, professor of Medicine at the University of Toronto and presenting author said in a statement.
Daneman will presenting the results of the study on Friday afternoon.
Study Parameters and Results
The study compared the safety and effectiveness of antibiotic courses in 3,608 patients with bloodstream infections across 74 hospitals in seven countries. Both treatment durations demonstrated similar 90-day mortality and relapse rates. Findings were consistent across secondary clinical outcomes and pre-specified patient, pathogen and syndrome subgroups.2
Antibiotic selection, dosing and route were at the discretion of the treating team, according to the investigators. They excluded patients with severe immune-suppression, foci requiring prolonged treatment, single cultures with potential contaminants, or cultures yielding Staphylococcus aureus.3
Their primary outcome was 90-day mortality, with a 4% absolute non-inferiority margin.3
“The primary outcome of 90-day mortality occurred in 261 (14.5%) patients receiving 7-day and in 286 (16.1%) receiving 14-day treatment (absolute difference -1.6% [95.7% confidence interval -4.0 to 0.8]), demonstrating non-inferiority of shorter duration treatment,” the investigators wrote. “A per-protocol analysis also demonstrated non-inferiority (-2.0% [95% confidence interval -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes, and pre-specified patient, pathogen and syndrome subgroups.”3
“These findings underscore the effectiveness of a shorter antibiotic regimen in patients with bloodstream infections, which is welcomed as we look to identify evidence-based prescribing guidelines for serious bacterial infections,” Daneman said.2
