An analysis of data from US hospitals in 2019 found that antibiotic treatment durations for uncomplicated gram-negative bloodstream infections (GN-BSIs) were longer than necessary, with marked variation among hospitals, researchers reported yesterday in Open Forum Infectious Diseases.
The observational study examined data on 4,240 episodes of GN-BSI (median patient age, 67 years; 51% male) at 24 US hospitals, all of which had antimicrobial stewardship programs. Half of the cases were uncomplicated, and 30% involved patients with compromised immune systems. The most frequent pathogens were Escherichia coli (53%), Klebsiella pneumoniae (21%), and Pseudomonas aeruginosa (8%).
The median duration of antibiotic treatment for all GN-BSI episodes was 12 days, with 59% of cases treated for 10 days or more. In the uncomplicated and immune-compromised subgroups, the median treatment duration was 11 days and 13 days, with 51% and 67% treated for 10 days or more, respectively. At the individual hospital level, median treatment durations ranged from 7 to 14 days, with a similar pattern of variability observed in the uncomplicated and immune-compromised subgroups.
A logistic regression model that included only uncomplicated cases found that isolation of a non-Enterobacterales organism, isolation of a multidrug-resistant organism, and lack of intravenous to oral antibiotic switch at day 5 were independently associated with prolonged treatment.
'Substantial opportunity' to reduce treatment durations
The study authors say the findings are noteworthy, because randomized trials have demonstrated the effectiveness of 7 days of therapy for uncomplicated GN-BSI. In addition, most physicians and pharmacists reported in a prior survey that their preferred duration of therapy was 7 days.
"Overall, our findings suggest there is likely substantial opportunity to reduce unnecessary variation in treatment durations for uncomplicated GN-BSI by promoting evidence-based, 7-day durations of therapy," they wrote. "This highlights the need to disseminate and scale successful interventions to reduce inappropriate variability in treatment durations."