TY - JOUR
T1 - Short versus long duration antimicrobial treatment for community-onset bacteraemia
T2 - A propensity score matching study
AU - Lee, Ching Chi
AU - Hsieh, Chih Chia
AU - Yang, Chao Yung
AU - Hong, Ming Yuan
AU - Lee, Chung Hsun
AU - Tang, Hung Jen
AU - Ko, Wen Chien
N1 - Funding Information:
The authors would like to thank all of the anonymous reviewers for their valuable comments and suggestions on improving quality of this study. This study was partially supported by research grants from the Ministry of Science and Technology of Taiwan [NSC102-2314-B-006-079], the Ministry of Health and Welfare of Taiwan [MOHW106-TDU-B-211-113003], Sin-Lau Hospital [SLH-M106-01 and SLH-M107-02] and National Cheng Kung University Hospital [NCKUH-10704031 and 10703021], Tainan, Taiwan. None declared. This study was approved by the Institutional Review Board of National Cheng Kung University Hospital (Tainan, Taiwan) [ER-100-182]. The requirement of obtaining informed consent was waived. Data are available from the corresponding author on reasonable request.
Funding Information:
This study was partially supported by research grants from the Ministry of Science and Technology of Taiwan [ NSC102-2314-B-006-079 ], the Ministry of Health and Welfare of Taiwan [ MOHW106-TDU-B-211-113003 ], Sin-Lau Hospital [SLH-M106-01 and SLH-M107-02] and National Cheng Kung University Hospital [ NCKUH-10704031 and 10703021 ], Tainan, Taiwan.
Publisher Copyright:
© 2019 Elsevier B.V. and International Society of Chemotherapy
PY - 2019/8
Y1 - 2019/8
N2 - The efficacy and safety of short-course intravenous (i.v.) antimicrobial therapy for bloodstream infections is unknown. Therefore, a retrospective 8-year cohort study including 1431 hospitalised adults was conducted to compare the outcomes of patients receiving short-course (5–10 days) and long-course (11–16 days) i.v. antibiotic therapy for community-onset bacteraemia. Of 1010 patients who received short-course therapy, 726 were matched with 363 patients in the long-course group through propensity score matching at a ratio of 1:2 based on independent predictors of 30-day mortality identified in the multivariate regression model. Following appropriate matching, similarities between the two groups in the proportion of baseline characteristics (age, sex, major co-morbidities, co-morbidity severity, bacteraemia severity at onset and major bacteraemia sources) and 30-day crude mortality rate after bacteraemia onset were observed. Notably, clinical outcomes within 30 days after the end of i.v. therapy, in terms of proportions of post-treatment overall infections (2.2% vs. 6.1%; P = 0.001), infections caused by antimicrobial-resistant pathogens (ARPs) (1.7% vs. 4.4%; P = 0.007), and thereby post-treatment crude mortality (1.4% vs. 3.6%; P = 0.009), were lower in the short-course group. In conclusion, for adults with community-onset uncomplicated bacteraemia, short-course (5–10 days) i.v. antibiotic treatment did not result in an increased risk of mortality but instead decreased the odds of overall and ARP infections after the treatment course.
AB - The efficacy and safety of short-course intravenous (i.v.) antimicrobial therapy for bloodstream infections is unknown. Therefore, a retrospective 8-year cohort study including 1431 hospitalised adults was conducted to compare the outcomes of patients receiving short-course (5–10 days) and long-course (11–16 days) i.v. antibiotic therapy for community-onset bacteraemia. Of 1010 patients who received short-course therapy, 726 were matched with 363 patients in the long-course group through propensity score matching at a ratio of 1:2 based on independent predictors of 30-day mortality identified in the multivariate regression model. Following appropriate matching, similarities between the two groups in the proportion of baseline characteristics (age, sex, major co-morbidities, co-morbidity severity, bacteraemia severity at onset and major bacteraemia sources) and 30-day crude mortality rate after bacteraemia onset were observed. Notably, clinical outcomes within 30 days after the end of i.v. therapy, in terms of proportions of post-treatment overall infections (2.2% vs. 6.1%; P = 0.001), infections caused by antimicrobial-resistant pathogens (ARPs) (1.7% vs. 4.4%; P = 0.007), and thereby post-treatment crude mortality (1.4% vs. 3.6%; P = 0.009), were lower in the short-course group. In conclusion, for adults with community-onset uncomplicated bacteraemia, short-course (5–10 days) i.v. antibiotic treatment did not result in an increased risk of mortality but instead decreased the odds of overall and ARP infections after the treatment course.
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U2 - 10.1016/j.ijantimicag.2019.05.014
DO - 10.1016/j.ijantimicag.2019.05.014
M3 - Article
C2 - 31108223
AN - SCOPUS:85068358107
VL - 54
SP - 176
EP - 183
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
SN - 0924-8579
IS - 2
ER -