Review Article Provides Guidance on Bacteremia FAQs

A new review article aims to tackle the most common questions hospitals face when dealing with uncomplicated non-Staphylococcus aureus bacteremia.

Given the dangers of antibiotic overuse, researchers from the US Department of Veterans Affairs and the University of Utah set out to distill what the existing medical literature says about the types of antibiotics that work best, the length of antibiotic use necessary, and the role of repeat blood cultures. They published their findings last month.

Jesse Sutton, PharmD, BCPS, antimicrobial stewardship pharmacist at the VA Medical Center in Salt Lake City, said the goal of the paper was to provide brief, practical answers to the questions that arise multiple times a week in hospitals like his.

“Although not surprising, the theme of the review is really how little data there is to guide these common decisions,” he told Contagion ^®. “Fortunately, research in these areas seems to have increased lately (note most of the data covered in the review is from the last few years) with an appreciation for the importance of antimicrobial stewardship.”

Though randomized controlled trials are few, the existing research supports the use of high bioavailability oral agents for uncomplicated bacteremia, the authors said. Oral beta-lactams are a viable consideration after initial intravenous treatment, “particularly in the setting of a pathogen with sufficiently low minimum inhibitory concentration and a patient who is not predisposed low beta-lactam concentrations,” the authors wrote.

As for the duration of treatment, Dr. Sutton told Contagion ^® there’s a growing body of evidence suggesting that the standard durations are longer than necessary. He said it’s wrong to assume that a longer duration of antibiotics is “playing it safe.”

“The most commonly used duration of 14 days is really an arbitrary time point established prior to an appreciation for the unintended consequences of antibiotic use,” Dr. Sutton said. “It is unfortunate using an antibiotic longer than it is needed has ever been considered ‘safe.’”

Most recently, Dr. Sutton added, Dafna Yahav, MD, of the University of Tel Aviv, reported that a 7-day course of antibiotics was not inferior to a 14-day course for patients with gram-negative bacteremia. Those findings were reported at the European Congress of Clinical Microbiology and Infectious Diseases.

Such findings, according to Dr. Sutton, have been consistent in showing no benefit to longer duration. The trouble, he said, is that the studies usually only involve a few hundred individuals, and thus, they’re not large enough to consistently identify harmful societal effects of excessive use of antibiotics.

“The existing data, while still limited, does suggest the mentality really should be ‘it is safer to use a shorter duration’ if the patient is better and has an uncomplicated infection based,” he said.

When it comes to repeat blood cultures, Dr. Sutton and colleagues found “limited added value” in routinely repeating blood cultures to confirm bloodstream clearance; repeated blood cultures should only be done in specific circumstances.

“We suggest obtaining repeat blood cultures when the source of bacteremia is unknown or there is lack of clinical improvement raising concern for complicated infection,” he said.