Outcomes of 7 or 14 days antibiotic therapy for bloodstream infection found comparable: NEJM

A new study published in the New England Journal of Medicine showed that antibiotic therapy for 7 days was not inferior to treatment for 14 days among patients hospitalized with bloodstream infections. An estimated 2.9 million people worldwide die from bloodstream infections each year, making it one of the most serious forms of bacterial diseases. Although the recommended period of antibiotic therapy is 14 days or more, nothing is known about how long it should last for bloodstream infections. Shorter antibiotic treatments raise the possibility of clinical failure or infection recurrence.

The BALANCE Investigators from the University of Toronto decided to find out if the mortality rates following 7 and 14 days of antibiotic use were comparable. Also, they expected that shortened antibiotic duration might lower adverse events, antibiotic exposure, and resistant organism infections.

This research randomly allocated hospitalized patients with bloodstream infections, including the ones in the intensive care unit [ICU], to receive antibiotic therapy for 7 or 14 days. The treating team made decisions about the choice, dosage, and route of antibiotics. The patients with severe immunosuppression, foci that needed ongoing care, single cultures that could have been contaminated, or cultures that produced Staphylococcus aureus were not included. With a noninferiority margin of 4 percentage points, the main outcome was mortality from any cause within 90 days after the bloodstream infection diagnosis.

The intention-to-treat analysis comprised a total of 3608 randomly assigned patients from 74 hospitals across 7 countries where 1814 patients received antibiotic therapy for 7 days, and 1794 patients received antibiotic treatment for 14 days. 45.0% of patients were on hospital wards and 55.0% were in the intensive care unit at the time of inclusion. 75.4% of infections were contracted in the community, 13.4% in hospital wards, and 11.2% in intensive care units.

The urinary tract (42.2%), abdomen (18.8%), lung (11.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%) were the most frequent sites of bacteremia. By 90 days, 286 patients (16.1%) who had received antibiotics for 14 days and 261 patients (14.5%) who had received antibiotics for 7 days had passed away, demonstrating that the shorter treatment time was not inferior.

10.7% of patients in the 14-day group and 23.1% of patients in the 7-day group received treatment for longer than the allotted amount of time. Overall, antibiotic therapy for 7 days was comparable to treatment for 14 days in hospitalized patients with bloodstream infections.

Source:

(2024). Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2404991