Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

Abstract

<p class="first" id="d1458304e214">Among adults receiving short-course (6–10 days) vs prolonged-course (11–16 days) antibiotic therapy for Enterobacteriaceae bacteremia, no difference in 30-day mortality or recurrent bacteremia was observed. Short-course antibiotic therapy may be protective against the emergence of multidrug-resistant bacteria. </p><div class="section"> <a class="named-anchor" id="s1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1458304e220">Background</h5> <p id="d1458304e222">The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7–14 days. We compared the outcomes of patients receiving short-course (6–10 days) vs prolonged-course (11–16 days) antibiotic therapy for Enterobacteriaceae bacteremia. </p> </div><div class="section"> <a class="named-anchor" id="s2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1458304e225">Methods</h5> <p id="d1458304e227">A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6–16 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 comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, <i>Clostridium difficile</i> infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. </p> </div><div class="section"> <a class="named-anchor" id="s3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1458304e233">Results</h5> <p id="d1458304e235">There were 385 well-balanced matched pairs. 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 mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], .62–1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI, .32–1.09; <i>P</i> = .09). </p> </div><div class="section"> <a class="named-anchor" id="s4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1458304e241">Conclusions</h5> <p id="d1458304e243">Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria. </p> </div>