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- Title
Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm.
- Authors
Herrera, Fabián; Torres, Diego; Laborde, Ana; Jordán, Rosana; Tula, Lucas; Mañez, Noelia; Pereyra, María Laura; Suchowiercha, Nadia; Berruezo, Lorena; Gudiol, Carlota; Ibáñez, María Luz González; Eusebio, María José; Lambert, Sandra; Barcán, Laura; Rossi, Inés Roccia; Nicola, Federico; Pennini, Magdalena; Monge, Renata; Blanco, Miriam; Visús, Mariángeles
- Abstract
Purpose: Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14 days. Methods: This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7 days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14 days of AT. Results: Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9 days (IQR: 7–15) vs. 14 days (IQR: 13–22) (p = < 0.001). Conclusions: These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.
- Subjects
HEMATOPOIETIC stem cells; HEMATOLOGIC malignancies; STEM cell transplantation; BACTEREMIA; LENGTH of stay in hospitals
- Publication
European Journal of Clinical Microbiology & Infectious Diseases, 2024, Vol 43, Issue 9, p1741
- ISSN
0934-9723
- Publication type
Article
- DOI
10.1007/s10096-024-04885-w