Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort

Darunee Chotiprasitsakul, Jennifer H. Han, Sara Cosgrove, Anthony D. Harris, Ebbing Lautenbach, Anna T. Conley, Pam Tolomeo, Jacqueleen Wise, Pranita Tamma

Research output: Contribution to journalArticle

Abstract

Background The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. Results There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI],.62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI,.32-1.09; P =.09). Conclusions Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.

Original languageEnglish (US)
Pages (from-to)172-177
Number of pages6
JournalClinical Infectious Diseases
Volume66
Issue number2
DOIs
StatePublished - Jan 15 2018

Fingerprint

Propensity Score
Enterobacteriaceae
Bacteremia
Anti-Bacterial Agents
Gram-Negative Bacteria
Therapeutics
Clostridium Infections
Clostridium difficile
Enterobacteriaceae Infections
Confidence Intervals
Mortality
Infection
Cohort Studies
Retrospective Studies
Odds Ratio
Regression Analysis

Keywords

  • antibiotics
  • duration of therapy
  • gram-negative bacteremia
  • multidrug-resistant

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort. / Chotiprasitsakul, Darunee; Han, Jennifer H.; Cosgrove, Sara; Harris, Anthony D.; Lautenbach, Ebbing; Conley, Anna T.; Tolomeo, Pam; Wise, Jacqueleen; Tamma, Pranita.

In: Clinical Infectious Diseases, Vol. 66, No. 2, 15.01.2018, p. 172-177.

Research output: Contribution to journalArticle

Chotiprasitsakul, Darunee ; Han, Jennifer H. ; Cosgrove, Sara ; Harris, Anthony D. ; Lautenbach, Ebbing ; Conley, Anna T. ; Tolomeo, Pam ; Wise, Jacqueleen ; Tamma, Pranita. / Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort. In: Clinical Infectious Diseases. 2018 ; Vol. 66, No. 2. pp. 172-177.
@article{5f8bf117a40d46e8936b5a2c22463cd3,
title = "Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort",
abstract = "Background The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. Results There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95{\%} confidence interval [CI],.62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95{\%} CI,.32-1.09; P =.09). Conclusions Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.",
keywords = "antibiotics, duration of therapy, gram-negative bacteremia, multidrug-resistant",
author = "Darunee Chotiprasitsakul and Han, {Jennifer H.} and Sara Cosgrove and Harris, {Anthony D.} and Ebbing Lautenbach and Conley, {Anna T.} and Pam Tolomeo and Jacqueleen Wise and Pranita Tamma",
year = "2018",
month = "1",
day = "15",
doi = "10.1093/cid/cix767",
language = "English (US)",
volume = "66",
pages = "172--177",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort

AU - Chotiprasitsakul, Darunee

AU - Han, Jennifer H.

AU - Cosgrove, Sara

AU - Harris, Anthony D.

AU - Lautenbach, Ebbing

AU - Conley, Anna T.

AU - Tolomeo, Pam

AU - Wise, Jacqueleen

AU - Tamma, Pranita

PY - 2018/1/15

Y1 - 2018/1/15

N2 - Background The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. Results There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI],.62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI,.32-1.09; P =.09). Conclusions Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.

AB - Background The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia. Methods A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy. Results There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI],.62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI,.32-1.09; P =.09). Conclusions Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.

KW - antibiotics

KW - duration of therapy

KW - gram-negative bacteremia

KW - multidrug-resistant

UR - http://www.scopus.com/inward/record.url?scp=85040634489&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040634489&partnerID=8YFLogxK

U2 - 10.1093/cid/cix767

DO - 10.1093/cid/cix767

M3 - Article

C2 - 29190320

AN - SCOPUS:85040634489

VL - 66

SP - 172

EP - 177

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 2

ER -