Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database
- Authors: Gajdos, Lena; Buetti, Niccolo; Tabah, Alexis; Ruckly, Stephane; Akova, Murat; Sjöval, Frederik; Arvanti, Kostoula; de Waele, Jan; Bracht, Hendrik; Barbier, Francois; Timsit, Jean-François;Alexis Tabah, Jeffrey Lipman, Alexis Tabah, Hamish Pollock, Ben Margetts, Andrew Udy, Meredith Young, Neeraj Bhadange, Steven Tyler, Anne Ledtischke, Mackenzie Finnis, Anne Ledtischke, Mackenzie Finnis, Jyotsna Dwivedi, Manoj Saxena, Vishwanath Biradar, Natalie Soar, Vineet Sarode, David Brewster, Adrian Regli, Elizabeth Weeda, Samiul Ahmed, Cheryl Fourie, Kevin Laupland, Mahesh Ramanan, James Walsham, Jason Meyer, Edward Litton, Anna Maria Palermo, Timothy Yap, Ege Eroglu, Antony George Attokaran, C'havala Jaramillo, Khalid Mk Nafees, Khalid Mahmood Khan Nafees, Nurhikmahtul Aqilah Haji Abd Rashid, Haji Adi Muhamad Ibnu Walid, Tomas Mon, P Dhakshina Moorthi, Shah Sudhirchandra, Dhadappa Damodar Sridharan, Qiu Haibo, Jianfeng Xie, Qiu Haibo, Xie Jianfeng, Lu Wei-Hua, Wang Zhen, Chuanyun Qian, Jili Luo, Xiaomei Chen, Hao Wang, Peng Zhao, Juan Zhao, Qiu Wusi, Chen Mingmin, Lei Xu, Chengfen Yin, Ruilan Wang, Jinfeng Wang, Yongjie Yin, Min Zhang, Jilu Ye, Chungfang Hu, Suming Zhou, Min Huang, Jing Yan, Yan Wang, Bingyu Qin, Ling Ye, Xie Weifeng, Li Peije, Nan Geng, Lowell Ling, Lowell Ling, Yoshiro Hayashi, Yoshiro Hayashi, Toshiyuki Karumai, Masaki Yamasaki, Satoru Hashimoto, Koji Hosokawa, Jun Makino, Takeo Matsuyoshi, Akira Kuriyama, Hidenobu Shigemitsu, Yuka Mishima, Michio Nagashima, Hideki Yoshida, Shigeki Fujitani, Koichiro Omori, Hiroshi Rinka, Hiroki Saito, Kaori Atobe, Hideaki Kato, Shunsuke Takaki, Helmi Sulaiman, M Shahnaz Hasan, Muhamad Fadhil Hadi Jamaluddin, Lee See Pheng, Sheshendrasurian Visvalingam, Mun Thing Liew, Siong Ling Danny Wong, Kean Khang Fong, Hamizah Bt Abdul Rahman, Zuraini Md Noor, Lee Kok Tong, Abd Hamid Azman, Mohd Zulfakar Mazlan, Saedah Ali, Aaron Mark Hernandez, Anton Abello, Kyeongman Jeon, Kyeongman Jeon, Sang-Min Lee, Sunghoon Park, Seung Yong Park, Sung Yoon Lim, Andrea Lay Hoon Kwa, Qing Yuan Goh, Qing Yuan Goh, Shin Yi Ng, Sui An Lie, Andrea Lay Hoon Kwa, Ken Junyang Goh, Andrew Yunkai Li, Caroline Yu Ming Ong, Jia Yan Lim, Jessica Lishan Quah, Kangqi Ng, Tony Yu-Chang Yeh, Yu Chang Yeh, Nai-Kuan Chou, Cong-Tat Cia, Ting-Yu Hu, Li-Kuo Kuo, Shih-Chi Ku, Phunsup Wongsurakiat, Phunsup Wongsurakiat, Yutthana Apichatbutr, Supattra Chiewroongro, Adel Alsisi, Rashid Nadeem, Ashraf El Houfi, Adel Alsisi, Adel Alsisi, Amr Elhadidy, Mina Barsoum, Nermin Osman, Tarek Mostafa, Mohamed Elbahnasawy, Ahmed Saber, Amer Aldhalia, Omar Elmandouh, Ahmed Elsayed, Merihan A Elbadawy, Ahmed K Awad, Hanan M Hemead, Farid Zand, Farid Zand, Maryam Ouhadian, Seyed Hamid Borsi, Zahra Mehraban, Davood Kashipazha, Fatemeh Ahmadi, Mohsen Savaie, Farhad Soltani, Mahboobeh Rashidi, Reza Baghbanian, Fatemeh Javaherforoosh, Fereshteh Amiri, Arash Kiani, Mohammad Amin Zargar, Ata Mahmoodpoor, Fatemeh Aalinezhad, Gholamreza Dabiri, Golnar Sabetian, Hakimeh Sarshad, Mansoor Masjedi, Ramin Tajvidi, Seyed Mohammad Nasirodin Tabatabaei, Abdullah Khudhur Ahmed, Pierre Singer, Pierre Singer, Ilya Kagan, Merav Rigler, Daniel Belman, Phillip Levin, Belal Harara, Adei Diab, Fayez Abillama, Fayez Abilama, Rebecca Ibrahim, Aya Fares, Muhammed Elhadi, Ahmad Buimsaedah, Marwa Gamra, Ahmed Aqeelah, Almajdoub Mohammed AliAli, Ahmed Gaber Sadik Homaidan, Bushray Almiqlash, Hala Bilkhayr, Ahmad Bouhuwaish, Ahmed Sa Taher, Eman Abdulwahed, Fathi A Abousnina, Aisha Khaled Hdada, Rania Jobran, Hayat Ben Hasan, Rabab Shaban Ben Hasan, Khalid Abidi, Issam Serghini, Rachid Seddiki, Brahim Boukatta, Nabil Kanjaa, Doumiri Mouhssine, Maazouzi Ahmed Wajdi, Tarek Dendane, Amine Ali Zeggwagh, Brahim Housni, Oujidi Younes, Abdelhamid Hachimi, A Ghannam, Z Belkhadir, Sarah Amro, Mustafa Abu Jayyab, Ali Aithssain, Ali Ait Hssain, Abdurahaman Elbuzidi, Edin Karic, Marcus Lance, Shaikh Nissar, Hend Sallam, Omar Elrabi, Ghal
- Publication year: 2025
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/677023
Abstract
Introduction: Hospital-acquired bloodstream infections (HA-BSIs) are severe and require antibiotic therapy. In non-complicated BSIs, shortened therapy reduces side effects without compromising efficacy. The impact of shortened antibiotic therapy in HA-BSI critically ill patients without indication of prolonged therapy requires further evaluation. Methods: Using the international prospective EUROBACT-2 cohort, we compared shortened (7-10 days) versus long (14-21 days) treatment durations in ICU patients eligible for shortened therapy. Patients without antibiotic therapy within 3 days after HA-BSI occurrence or requiring prolonged therapy (due to infection source, microorganism, or clinical deterioration) were excluded. Treatment failure, defined as death, persistent infection, or subsequent infectious complications by Day 28, was assessed using an inverse-probability of treatment weighted (IPTW) logistic regression. Results: Among 2600 patients, 550 were eligible for shortened treatment, 213 received short, and 337 received long treatment. The most common infection source was intravascular catheters (33%), most common microorganisms were Enterobacterales (39%). Patients with long treatment were more frequently infected with Staphylococcus aureus (11% vs. 5.6%, p = 0.025) or difficult-to-treat microorganisms (23% vs. 7%, p < 0.001), and received more commonly combination therapy (46% vs. 30%, p < 0.001). Short treatment was associated with reduced 28-day treatment failure (OR 0.64, 95% CI 0.44-0.93, p = 0.019), mainly due to reduction in subsequent infectious complications (OR 0.58, 95% CI 0.37-0.91, p = 0.018). Mortality (OR 0.92 [95% CI 0.59, 1.43], p = 0.7) and persistent infection rates (OR 0.47 [95% CI 0.17, 1.14], p = 0.12) were similar. Conclusions: In selected ICU patients with HA-BSI, shortened antibiotic treatment might be considered. Eurobact2 was a prospective international cohort study, registered in ClinicalTrials.org (NCT03937245).