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In Brief | Antimicrobials
Optimal Duration of Antibiotic Treatment for Bloodstream Infections
Time to read: 01:57
Time to listen: 04:18
Originally Published: 20 November 2024
Source: NEJM
Type of article: In Brief
MedED Catalogue Reference: MIIB017
Category: Antimicrobials
Cross Reference: Infectious Diseases, Critical Care
Keywords: Antimicrobials, AMR, antibiotic stewardship
Key Takeaway
This article is a review of recent studies originally published in the NEJM,20 November 2024. This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
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Bloodstream infections (BSIs) carry a high risk of morbidity and mortality. While early and appropriate antimicrobial treatment is essential, the ideal duration of therapy remains a matter of clinical debate.
Study Purpose
This randomised, multicentre, noninferiority study, published in the NEJM, investigated whether a 7-day antibiotic regimen is as effective as a 14-day regimen for hospitalised patients with bloodstream infections, by assessing noninferiority in terms of 90-day all-cause mortality.
Study Methodology
Adults admitted to hospital, including those in intensive care, with confirmed bloodstream infections were eligible for inclusion.
Participants were randomly allocated to receive either 7 or 14 days of antibiotic therapy, with the choice of agent, dose, and route left to the treating clinicians.
Exclusions included patients with marked immunosuppression, infections needing extended treatment durations, likely contaminants, or Staphylococcus aureus bloodstream infections.
The primary endpoint was mortality from any cause within 90 days of diagnosis, with a pre-specified noninferiority margin of 4 percentage points.
Findings
A total of 3608 patients were included in the intention-to-treat analysis—1814 in the 7-day arm and 1794 in the 14-day arm.
Just over half (55%) were admitted to the ICU at the time of enrolment, with the remainder (45%) in general wards.
The majority of infections were community-acquired (75.4%), followed by hospital-acquired (13.4%) and ICU-acquired (11.2%).
Primary infection sources included the urinary tract (42.2%), intra-abdominal sites (18.8%), lungs (13%), vascular access devices (6.3%), and skin/soft tissue (5.2%).
The following findings were recorded:
At 90 days, mortality was 14.5% in the 7-day group and 16.1% in the 14-day group (absolute difference −1.6 percentage points; 95.7% CI, −4.0 to 0.8), demonstrating noninferiority.
Results were consistent across secondary endpoints and prespecified subgroups.
Conclusion
The findings provide robust evidence supporting the safety of a shorter antibiotic course in a broad hospitalised population with BSI, excluding certain high-risk groups. The consistency across subgroups and outcomes strengthens the validity of the results.
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