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Critical Care
Published in: Critical Care 6/2011

Open Access 01-12-2011 | Research

Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

Authors: Thomas C Havey, Robert A Fowler, Nick Daneman

Published in: Critical Care | Issue 6/2011

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Abstract

Introduction

The optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs.

Methods

A search of the MEDLINE, EMBASE and COCHRANE databases was conducted for the years 1947-2010. Controlled trials were identified that randomized patients to shorter versus longer durations of treatment for bacteremia, or the infectious foci most commonly causing bacteremia in critically ill patients (catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI)).

Results

Twenty-four eligible trials were identified, including one trial focusing exclusively on bacteremia, zero in catheter related bloodstream infection, three in intra-abdominal infection, six in pyelonephritis, thirteen in pneumonia and one in skin and soft tissue infection. Thirteen studies reported on 227 patients with bacteremia allocated to 'shorter' or 'longer' durations of treatment. Outcome data were available for 155 bacteremic patients: neonatal bacteremia (n = 66); intra-abdominal infection (40); pyelonephritis (9); and pneumonia (40). Among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure (45/52 versus 47/49, risk ratio 0.88, 95% confidence interval [CI] 0.77-1.01), microbiologic cure (28/28 versus 30/32, risk ratio 1.05, 95% CI 0.91-1.21), and survival (15/17 versus 26/29, risk ratio 0.97, 95% CI 0.76-1.23).

Conclusions

No significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings.
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Literature
1.
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754CrossRefPubMed
2.
Valles J, Leon C, Alvarez-Lerma F: Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 1997, 24: 387-395. 10.1093/clinids/24.3.387CrossRefPubMed
3.
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB: The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997, 24: 584-602.CrossRefPubMed
4.
Renaud B, Brun-Buisson C: Outcomes of primary and catheter-related bacteremia. Am J Respir Crit Care Med 2001, 163: 1584-1590.CrossRefPubMed
5.
Garrouste-Orgeas M, Timsit JF, Tafflet M, Misset B, Zahar JR, Soufir L, Lazard T, Jamali S, Mourvillier B, Cohen Y, De Lassence A, Azoulay E, Cheval C, Descorps-Declere A, Adrie C, Costa de Beauregard MA, Carlet J, OUTCOMEREA Study Group: Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis 2006, 42: 1118-1126. 10.1086/500318CrossRefPubMed
6.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006, 34: 1589-1596. 10.1097/01.CCM.0000217961.75225.E9CrossRefPubMed
7.
Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH: The influence of inadequate antimicrobial treatment on patient outcomes in the ICU setting. Chest 2000, 118: 146-155. 10.1378/chest.118.1.146CrossRefPubMed
8.
McGregor JC, Rich SE, Harris AD, Perencevich EN, Osih R, Lodise TP Jr, Miller RR, Furuno JP: A systematic review of the methods used to assess the association between appropriate antibiotic therapy and mortality in bacteremic patients. Clin Infect Dis 2007, 45: 329-337. 10.1086/519283CrossRefPubMed
9.
Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ: Unnecessary use of antimicrobials in hospitalized patients. Arch Intern Med 2003, 163: 972-978. 10.1001/archinte.163.8.972CrossRefPubMed
10.
Rice LB: The Maxwell Finland lecture: for the duration--rational antibiotic administration in an era of antimicrobial resistance and Clostridium difficile . Clin Infect Dis 2008, 46: 491-496. 10.1086/526535CrossRefPubMed
11.
Hayashi Y, Paterson DL: Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011, 52: 1232-1240. 10.1093/cid/cir063CrossRefPubMed
12.
Rubinstein E: Short antibiotic treatment courses or how short is short? Int J Antimicrob Agents 2007, 30: 76-79.CrossRef
13.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America; American Thoracic Society: Infectious Diseases Society of America/American Thoracic Society Consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007, 44: S27-72. 10.1086/511159CrossRefPubMed
14.
American Thoracics Society/Infectious Diseases Society of America: Guidelines for management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005, 171: 388-416.CrossRef
15.
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG: Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious diseases Society of America. Clin Infect Dis 2010, 50: 133-164. 10.1086/649554CrossRefPubMed
16.
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009, 49: 1-45. 10.1086/599376PubMedCentralCrossRefPubMed
17.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE, Infectious Diseases Society of America; European Society for Microbiologyand Infectious Diseases: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011, 52: e103-e120. 10.1093/cid/ciq257CrossRefPubMed
18.
Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC, Infectious Diseases Society of America: Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005, 41: 1373-1406. 10.1086/497143CrossRefPubMed
19.
Corona A, Bertolini G, Ricotta AM, Wilson AP, Singer M: Variability of treatment duration for bacteraemia in the critically ill: a multinational survey. J Antimicrob Chemother 2003, 53: 849-852.CrossRef
20.
Daneman N, Shore K, Pinto R, Fowler R: Antibiotic treatment duration for bloodstream Infections in critically ill patients: a national survey of Canadian infectious diseases and critical care specialists. Int J Antimicr Agents 2011, 38: 480-485. 10.1016/j.ijantimicag.2011.07.016CrossRef
21.
Kyriakidou KG, Rafailidis P, Matthaiou DK, Athanasiou S, Falagas ME: Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials. Clin Ther 2008, 30: 1859-1868. 10.1016/j.clinthera.2008.10.007CrossRefPubMed
22.
Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME: Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs 2008, 68: 1841-1854. 10.2165/00003495-200868130-00004CrossRefPubMed
23.
Li JZ, Winston LG, Moore DH, Bent S: Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med 2007, 120: 783-790. 10.1016/j.amjmed.2007.04.023CrossRefPubMed
24.
25.
26.
Chowdhary G, Dutta S, Narang A: Randomized controlled trial of 7-day vs. 14-day antibiotics for neonatal sepsis. J Trop Pediatr 2006, 52: 427-432. 10.1093/tropej/fml054CrossRefPubMed
27.
Basoli A, Chirletti P, Cirino E, D'Ovidio NG, Doglietto GB, Giglio D, Giulini SM, Malizia A, Taffurelli M, Petrovic J, Ecari M, Italian Study Group: A prospective, double-blind, multicenter, randomized trial comparing ertapenem 3 vs ≥ 5 days in community-acquired intraabdominal infection. J Gastrointest Surg 2008, 12: 592-600. 10.1007/s11605-007-0277-xCrossRefPubMed
28.
Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA: Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. Gastroenterology 1991, 100: 1737-1742.PubMed
29.
Chaudhry ZI, Nisar S, Ahmed U, et al.: Short course of antibiotic treatment in spontaneous bacterial peritonitis: a randomized controlled study. JCPSP 2000, 10: 284-288.
30.
Engle WD, Jackson GL, Sendelbach DM, Stehel EK, Ford DM, McHugh KM, Norris MR, Vedro DA, Velaphi S, Michelow IC, Olsen KD: Pneumonia in term neonates: laboratory studies and duration of antibiotic therapy. J Perinatol 2003, 23: 372-377. 10.1038/sj.jp.7210949CrossRefPubMed
31.
Engle WD, Jackson GL, Sendelbach D, Ford D, Olesen B, Burton KM, Pritchard MA, Frawley WH: Neonatal pneumonia: comparison of 4 vs 7 days of antibiotic therapy in term and near-term infants. J Perinatol 2000, 20: 421-426. 10.1038/sj.jp.7200416CrossRefPubMed
32.
Vuori-Holopainen E, Peltola H, Kallio MJ, SE-TU Study Group: Narrow- versus broad-spectrum parenteral antimicrobials against common infections of childhood: a prospective and randomised comparison between penicillin and cefuroxime. Eur J Pediatr 2000, 159: 878-884. 10.1007/PL00008360CrossRefPubMed
33.
Agarwal G, Awasthi S, Kabra SK, Kaul A, Singhi S, Walter SD, ISCAP Study Group: Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial. BMJ 2004, 328: 791.CrossRefPubMed
34.
Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) pneumonia study group: Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet 2002, 360: 835-841.CrossRef
35.
File TM Jr, Mandell LA, Tillotson G, Kostov K, Georgiev O: Gemifloxacin once daily for 5 days versus 7 days for the treatment of community-acquired pneumonia: a randomized, multicentre, double blind study. J Antimicrob Chemother 2007, 60: 112-120. 10.1093/jac/dkm119CrossRefPubMed
36.
Tellier G, Niederman MS, Nusrat R, Patel M, Lavin B: Clinical and bacteriological efficacy and safety of 5 and 7 day regimens of telithromycin once daily compared with a 10 day regimen of clarithromycin twice daily in patients with mild to moderate community-acquired pneumonia. J Antimicrob Chemother 2004, 54: 515-523. 10.1093/jac/dkh356CrossRefPubMed
37.
Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, Wiesinger BA, Xiang JX, Zadeikis N, Kahn JB: High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis 2003, 37: 752-760. 10.1086/377539CrossRefPubMed
38.
Siegel RE, Alicea M, Lee A, Blaiklock R: Comparison of 7 versus 10 days of antibiotic therapy for hospitalized patients with uncomplicated community-acquired pneumonia: a prospective, randomized, double blind study. Am J Ther 1999, 6: 217-222. 10.1097/00045391-199907000-00007CrossRefPubMed
39.
Leophonte P, Choutet P, Gaillat J, et al.: Efficacy of a ten day course of ceftriaxone compared to a shortened five day course in the treatment of community-acquired pneumonia in hospitalized adults with risk factors. Medecine et Maladies Infectieuses 2002, 32: 369-381. 10.1016/S0399-077X(02)00384-0CrossRef
40.
el Moussaoui R, de Borgie CA, van den Broek P, Hustinx WN, Bresser P, van den Berk GE, Poley JW, van den Berg B, Krouwels FH, Bonten MJ, Weenink C, Bossuyt PM, Speelman P, Opmeer BC, Prins JM: Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ 2006, 332: 1355-1360. 10.1136/bmj.332.7554.1355PubMedCentralCrossRefPubMed
41.
Fekih Hassen M, Ayed S, Ben Sik Ali H, Gharbi R, Marghli S, Elatrous S: Duration of antibiotic therapy for ventilator-associated pneumonia: comparison of 7 and 10 days. Ann Fr Anesth Reanim 2009, 28: 16-23. 10.1016/j.annfar.2008.10.021CrossRefPubMed
42.
Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S, PneumA TrialGroup: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290: 2588-2598. 10.1001/jama.290.19.2588CrossRefPubMed
43.
de Gier R, Karperien A, Bouter K, Zwinkels M, Verhoef J, Knol W, Boon T, Hoepelman IM: A sequential study of intravenous and oral fleroxacin for 7 or 14 days in the treatment of complicated urinary tract infections. Int J Antimicrob Agents 1995, 6: 27-30. 10.1016/0924-8579(95)00011-VCrossRefPubMed
44.
Stamm WE, McKevitt M, Counts GW: Acute renal infection in women: treatment with trimethoprim-sulfamethoxazole or ampicillin for two or six weeks. Ann Intern Med 1987, 106: 341.CrossRefPubMed
45.
Gleckman R, Bradley P, Roth R, Hibert D, Pelletier C: Therapy of symptomatic pyelonephritis in women. J Urol 1985, 133: 176-178.PubMed
46.
Pylkkanen J, Vilska J, Koskimies O: The length of antimicrobial therapy in lower vs. upper urinary tract infection of childhood. Acta Paediatr Scand 1981, 70: 885-888. 10.1111/j.1651-2227.1981.tb06245.xCrossRefPubMed
47.
Jernelius H, Zbornik J, Bauer CA: One or three weeks' treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam. Acta Med Scand 1988, 223: 469-477.CrossRefPubMed
48.
Cheng C, Tsau Y, Lin T: Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics 2006, 117: e84-e89. 10.1542/peds.2005-0917CrossRefPubMed
49.
Hepburn MJ, Dooley DP, Skidmore PJ, Ellis MW, Starnes WF, Hasewinkle WC: Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med 2004, 164: 1669-1674. 10.1001/archinte.164.15.1669CrossRefPubMed
50.
Liu C, Bayer A, Cosgrove SE, et al.: Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of Methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011, 52: 1-38. 10.1093/cid/ciq015CrossRef
51.
Jernigan JA, Farr BM: Short-course therapy of catheter-related Staphylococcus aureus bacteremia: a meta-analysis. Ann Intern Med 1993, 119: 304-311.CrossRefPubMed
52.
Ehni WF, Reller LB: Short-course therapy for catheter-associated Staphylococcus aureus bacteremia. Arch Intern Med 1989, 149: 533-536. 10.1001/archinte.149.3.533CrossRefPubMed
53.
Hedrick TL, Evans HL, Smith RL, McElearney ST, Schulman AS, Chong TW, Pruett TL, Sawyer RG: Can we define an ideal duration of antibiotic therapy? Surg Infect 2006, 7: 419-432. 10.1089/sur.2006.7.419CrossRef
54.
Scalera NM, File TM: How long should we treat community-acquired pneumonia? Curr Opin Infect Dis 2007, 20: 177-181. 10.1097/QCO.0b013e3280555072CrossRefPubMed
55.
File TM: Clinical efficacy of newer agents in short-duration therapy for community-acquired pneumonia. Clin Infect Dis 2004, 39: S159-164. 10.1086/421354CrossRefPubMed
56.
Klausner HA, Brown P, Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB: A trial of levofloxacin 750 mg once daily for 5 days versus ciprofloxacin 400 mg and/or 500 mg twice daily for 10 days in the treatment of acute pyelonephritis. Curr Med Res Opin 2007, 23: 2637-2645. 10.1185/030079907X233340CrossRefPubMed
57.
Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB: A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology 2008, 71: 17-22. 10.1016/j.urology.2007.09.002CrossRefPubMed
58.
Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, Reuning-Scherer J, Church DA: Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial. JAMA 2000, 283: 1583-1590. 10.1001/jama.283.12.1583CrossRefPubMed
Metadata
Title
Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis
Authors
Thomas C Havey
Robert A Fowler
Nick Daneman
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10545

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