Can We Shorten Antibiotic Treatment for Bacteremia? (NEJM Journal Watch) PDF

12/10/24, 10:47 PM Can We Shorten the Duration of Antibiotic Treatment for Bacteremia? SUMMARY AND COMMENT | INFECTIOUS DISEASES, GENERAL MEDICINE, HOSPITAL MEDICINE PRACTICE CHANGING December 10, 2024 Can We Shorten the Duration of Antibiotic T...

12/10/24, 10:47 PM Can We Shorten the Duration of Antibiotic Treatment for Bacteremia? SUMMARY AND COMMENT | INFECTIOUS DISEASES, GENERAL MEDICINE, HOSPITAL MEDICINE PRACTICE CHANGING December 10, 2024 Can We Shorten the Duration of Antibiotic Treatment for Bacteremia? Richard T. Ellison III, MD, reviewing The BALANCE Investigators N Engl J Med 2024 Nov 20 A multinational, controlled trial has affirmed that 7 days of antibiotic therapy is adequate for uncomplicated bacteremia. Traditionally, non–Staphylococcus aureus bacteremic infections have been most commonly managed with 14 days of intravenous antibiotic therapy. But given the safety and effectiveness of shorter-duration therapy for many nonbacteremic infections, the necessary length of treatment for bacteremia has been questioned. Investigators conducted an international, randomized noninferiority trial to assess 7 days compared with 14 days of antibiotic therapy in hospitalized patients with bloodstream infections. Patients were excluded if they had infections with S. aureus, were neutropenic, were severely immunocompromised, had prosthetic heart valves or endovascular grafts, or had other indications for more-prolonged therapy. The primary outcome was 90-day mortality from any cause. Among 3608 evaluable patients, 55% were hospitalized in an ICU and 21% were on mechanical ventilation. Most infections were community acquired (75%), and the most frequent sources were urinary tract (43%), intrabdominal or hepatobiliary (19%), and pulmonary (13%). Most infections were monomicrobial (gram-negative bacteria, 70%; gram-positive bacteria, 17%) with a small percentage polymicrobial (12%). Ninety-day mortality was 261 (14%) in the 7-day group and 286 (16%) in the 14-day group. Among patients in the intensive care unit and in those with gram-positive or gram-negative bacteremia, 7 and 14 days of antibiotics yielded similar results. Other than median number of antibiotic- free days (19 vs. 14), most secondary outcomes (e.g., ICU and in-hospital mortality, relapse of bacteremia, Clostridioides difficile infection, antibiotic-related adverse effects) did not differ significantly between groups. COMMENT These findings affirm and extend the findings of three smaller contemporaneous trials of 7-day versus 14-day antibiotic regimens for gram-negative bacteremia. Given that the routine management of bacteremic infections with 14 days of therapy was never based on objective data, I https://www.jwatch.org/na58162/2024/12/10/can-we-shorten-duration-antibiotic-treatment-bacteremia?query=etoc_jwgenmed&jwd=000101747637&js… 1/3 12/10/24, 10:47 PM Can We Shorten the Duration of Antibiotic Treatment for Bacteremia? see no reason to give >7 days of antibiotics for bacteremia except under the conditions excluded in this trial. However, even for those circumstances, we can hope that future controlled trials will determine if treatment length can be shortened. CITATIONS The BALANCE Investigators , for the Canadian Critical Care Trials Group. Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections. N Engl J Med 2024 Nov 20; [e-pub]. (https://doi.org/10.1056/NEJMoa2404991) SHARE DISCLOSURES LATEST IN GENERAL MEDICINE DEC 10, 2024 Global Burden of Pulmonary Arterial Hypertension Raja-Elie E. Abdulnour, MD DEC 10, 2024 Retraction of a Paper on Electronic Cigarettes DEC 5, 2024 Fezolinetant for Vasomotor Symptoms in Women for Whom Hormone Therapy Isn't an Option Marie Claire O'Dwyer, MB BCh BAO, MPH DEC 5, 2024 Early Surgery or Endoscopy for Painful Chronic Pancreatitis? David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) DEC 3, 2024 Corticosteroids for Pneumonia in Patients Admitted to General Medicine Units Daniel D. Dressler, MD, MSc, MHM, FACP https://www.jwatch.org/na58162/2024/12/10/can-we-shorten-duration-antibiotic-treatment-bacteremia?query=etoc_jwgenmed&jwd=000101747637&js… 2/3 12/10/24, 10:47 PM Can We Shorten the Duration of Antibiotic Treatment for Bacteremia? Richard T. Ellison III, MD Associate Editor NEJM JOURNAL WATCH INFECTIOUS DISEASES Biography Disclosures Summaries Guideline Watch 2024 An exclusive collection of 12 clinical guideline summaries that will directly impact how you practice medicine. DOWNLOAD NOW NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright © 2024 Massachusetts Medical Society. All rights reserved. The content of this site is intended for health care professionals. Copyright | Terms | Privacy Policy | Cookie Preferences https://www.jwatch.org/na58162/2024/12/10/can-we-shorten-duration-antibiotic-treatment-bacteremia?query=etoc_jwgenmed&jwd=000101747637&js… 3/3