An examination of data drawn from US hospitals in 2019 underlined that the periods of antibiotic treatment allocated for uncomplicated gram-negative bloodstream infections (GN-BSIs) were extended beyond what was required. This finding demonstrated considerable variation among hospitals, according to research published in Open Forum Infectious Diseases.
The study scrutinized information from 4,240 cases of GN-BSI treated in 24 American hospitals. These hospitals all implemented antimicrobial stewardship programs. Half of these infections were uncomplicated and 30% occurred in patients with compromised immune systems. Predominant pathogens included Escherichia coli (making up 53% of the cases), Klebsiella pneumoniae (21%), and Pseudomonas aeruginosa (8%).
The median treatment period for all the GN-BSI infections was 12 days, and a significant 59% of the patients received treatment for 10 days or more. This treatment duration was also extended in the uncomplicated and immune-compromised subgroups, with the median treatment periods reaching 11 and 13 days, and 51% and 67% of patients, respectively, undergoing treatment for 10 or more days. Individual hospitals presented median treatment durations ranging from 7 to 14 days, mirroring the pattern of variation seen in the two subgroups.
Logistic regression analysis of uncomplicated cases indicated that the isolation of a non-Enterobacterales organism, the isolation of a multidrug-resistant organism, and the absence of an intravenous to oral antibiotic switch at day 5 were distinctly associated with protracted treatment. The researchers emphasized the importance of these findings, given that various trials have displayed the efficacy of 7-day therapy for uncomplicated GN-BSI.
Furthermore, in a previous survey, most physicians and pharmacists cited their preference for a therapy duration of 7 days. The researchers concluded that their findings point towards a significant potential to minimize unnecessary treatment period variations for uncomplicated GN-BSI by advocating for the implementation of evidence-informed 7-day therapy duration. This conclusion underscores the requirement for the distribution and scaling of successful interventions to curb inappropriate variability in treatment durations.