Leila S Hojat1,2,3, Mary T Bessesen1,2,4,5, Misha Huang1,2,6,7,8, Margaret Reid9, Bryan C Knepper10, Matthew A Miller11,12, Katherine C Shihadeh10,13,14,15, Randolph V Fugit4,5,16, Timothy C Jenkins1,2,10,13,14. 1. Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 2. Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 3. Division of Infectious Diseases and HIV Medicine, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA. 4. Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA. 5. Infectious Diseases Section, Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA. 6. Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA. 7. Division of Infectious Diseases, University of Colorado Hospital, Aurora, Colorado, USA. 8. Department of Patient Safety and Quality, University of Colorado Hospital, Aurora, Colorado, USA. 9. Department of Biostatistics, University of Colorado School of Public Health, Aurora, Colorado, USA. 10. Department of Patient Safety and Quality, Denver Health, Denver, Colorado, USA. 11. Department of Pharmacy, University of Colorado Hospital, Aurora, Colorado, USA. 12. University of Colorado School of Pharmacy, Aurora, Colorado, USA. 13. Department of Medicine, Denver Health, Denver, Colorado, USA. 14. Division of Infectious Diseases, Denver Health, Denver, Colorado, USA. 15. Department of Pharmacy, Denver Health, Denver, Colorado, USA. 16. Department of Pharmacy, Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA.
Abstract
BACKGROUND: National guidelines for pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) do not address treatment duration for infections associated with bacteremia. We evaluated clinical outcomes of patients receiving shorter (5-9 days) versus longer (10-15 days) duration of antibiotics. METHODS: This was a multicenter retrospective cohort study of inpatients with uncomplicated PNA, UTI, or ABSSSI and associated bacteremia. The primary outcome was clinical failure, a composite of rehospitalization, reinitiation of antibiotics, or all-cause mortality within 30 days of antibiotic completion. Secondary outcomes included individual components of the primary outcome, Clostridioides difficile infection, and antibiotic-related adverse effects necessitating change in therapy. A propensity score-weighted logistic regression model was used to mitigate potential bias associated with nonrandom assignment of treatment duration. RESULTS: Of 408 patients included, 123 received a shorter treatment duration (median 8 days) and 285 received a longer duration (median 13 days). In the propensity-weighted analysis, the probability of the primary outcome was 13.5% in the shorter group and 11.1% in the longer group (average treatment effect, 2.4%; odds ratio [OR], 1.25; 95% confidence interval [CI], .65-2.40; P = .505). However, shorter courses were associated with higher probability of restarting antibiotics (OR, 1.62; 95% CI, 1.01-2.61; P = .046) and C. difficile infection (OR, 4.01; 95% CI, 2.21-7.59; P < .0001). CONCLUSIONS: Shorter courses of antibiotic treatment for PNA, UTI, and ABSSSI with bacteremia were not associated with increased overall risk of clinical failure; however, prospective studies are needed to further evaluate the effectiveness of shorter treatment durations.
BACKGROUND: National guidelines for pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) do not address treatment duration for infections associated with bacteremia. We evaluated clinical outcomes of patients receiving shorter (5-9 days) versus longer (10-15 days) duration of antibiotics. METHODS: This was a multicenter retrospective cohort study of inpatients with uncomplicated PNA, UTI, or ABSSSI and associated bacteremia. The primary outcome was clinical failure, a composite of rehospitalization, reinitiation of antibiotics, or all-cause mortality within 30 days of antibiotic completion. Secondary outcomes included individual components of the primary outcome, Clostridioides difficile infection, and antibiotic-related adverse effects necessitating change in therapy. A propensity score-weighted logistic regression model was used to mitigate potential bias associated with nonrandom assignment of treatment duration. RESULTS: Of 408 patients included, 123 received a shorter treatment duration (median 8 days) and 285 received a longer duration (median 13 days). In the propensity-weighted analysis, the probability of the primary outcome was 13.5% in the shorter group and 11.1% in the longer group (average treatment effect, 2.4%; odds ratio [OR], 1.25; 95% confidence interval [CI], .65-2.40; P = .505). However, shorter courses were associated with higher probability of restarting antibiotics (OR, 1.62; 95% CI, 1.01-2.61; P = .046) and C. difficileinfection (OR, 4.01; 95% CI, 2.21-7.59; P < .0001). CONCLUSIONS: Shorter courses of antibiotic treatment for PNA, UTI, and ABSSSI with bacteremia were not associated with increased overall risk of clinical failure; however, prospective studies are needed to further evaluate the effectiveness of shorter treatment durations.
Authors: Emily L Heil; Jacqueline T Bork; Lilian M Abbo; Tamar F Barlam; Sara E Cosgrove; Angelina Davis; David R Ha; Timothy C Jenkins; Keith S Kaye; James S Lewis; Jessica K Ortwine; Jason M Pogue; Emily S Spivak; Michael P Stevens; Liza Vaezi; Pranita D Tamma Journal: Open Forum Infect Dis Date: 2021-10-11 Impact factor: 3.835