Methods: Patients who survived hospitalization for gram-negative BSI without complications at Palmetto Health Richland and Baptist Hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were included in the study. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine treatment failure, defined as mortality or recurrence within 90 days of BSI.
Results: During the study period, 117 and 294 patients received short and long courses of antimicrobial therapy for uncomplicated gram-negative BSI. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median treatment duration with appropriate antimicrobial agents was 8.5 and 13.3 days in the short and long course groups, respectively. Patients in both groups received nearly 5 days of intravenous antimicrobial therapy. After adjustment for the propensity to use a short course of antimicrobial therapy, risk of treatment failure was higher in patients receiving short compared to long courses of antimicrobial agents (hazard ratio [HR] 2.6, 95% confidence intervals [CI]: 1.2-5.5, p=0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.8, 95% CI: 1.9-15.0, p=0.004) and immune compromised status (HR 4.3, 95% CI: 1.6-10.8, p=0.006). Definitive antimicrobial therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.3, 95% CI: 0.1-0.7, p=0.006).
Conclusion: The current results support common clinical practice of nearly 2 weeks of antimicrobial therapy for gram-negative BSI.
P. B. Bookstaver, Allergan Pharmaceuticals: Scientific Advisor , Research grant
J. Kohn, None
H. Albrecht, None
M. Al-Hasan, None
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