University of Toronto, Department of Medicine, Toronto, ON, Canada.
Int J Antimicrob Agents. 2011 Dec;38(6):480-5. doi: 10.1016/j.ijantimicag.2011.07.016. Epub 2011 Oct 7.
An optimum duration of antibiotic therapy would eradicate infection whilst minimising adverse drug reactions, resistance and costs. However, there is a paucity of evidence guiding the duration of therapy for bloodstream infections. Canadian infectious diseases (ID) and critical care specialists were surveyed regarding their recommended antibiotic treatment durations for five common bacteraemic syndromes. A descriptive analysis was performed to assess: (i) practice heterogeneity; (ii) equipoise for a trial of shorter versus longer therapy; and (iii) the influence of pathogen and host characteristics on recommendations. In total, 172 clinicians responded to the survey (60% ID, 39% critical care and 1% combined specialists). For each syndrome, the most common recommendation was 14 days, yet the majority of respondents recommended durations of ≤ 10 days. Median durations were similar for each syndrome: central vascular catheter-related bloodstream infection, 10 ± 3.6 days; bacteraemic pneumonia, 10 ± 2.8 days; bacteraemic urinary tract infection, 10 ± 3.8 days; bacteraemic intra-abdominal infection, 10 ± 4.1 days; and bacteraemic skin and soft-tissue infection, 14 ± 3.2 days. Respondents recommended the longest durations for Staphylococcus aureus and the shortest durations for coagulase-negative staphylococci. Most respondents would not modify duration based on host characteristics or measures of clinical response. ID physicians recommended longer durations than critical care physicians for all five syndromes, but the majority of both specialist groups would enrol patients in a trial of shorter (7 day) versus longer (14 day) antibiotic therapy. In conclusion, significant practice variation exists amongst clinicians' recommended durations of antibiotic treatment for bacteraemia. There is equipoise for a randomised trial comparing shorter versus longer courses of antibiotics for most bacteraemic syndromes and pathogens.
抗生素治疗的最佳持续时间应为在最小化药物不良反应、耐药性和成本的同时消除感染。然而，目前指导血流感染治疗持续时间的证据很少。对加拿大传染病（ID）和重症监护专家进行了调查，以了解他们对五种常见菌血症综合征的抗生素治疗持续时间的建议。采用描述性分析评估：（i）实践异质性；（ii）短疗程与长疗程试验的平衡；（iii）病原体和宿主特征对建议的影响。共有 172 名临床医生对调查做出了回应（60%为 ID，39%为重症监护，1%为综合专家）。对于每种综合征，最常见的建议是 14 天，但大多数受访者建议的持续时间≤10 天。每种综合征的中位数持续时间相似：中心血管导管相关血流感染，10±3.6 天；菌血症性肺炎，10±2.8 天；菌血症性尿路感染，10±3.8 天；菌血症性腹腔内感染，10±4.1 天；菌血症性皮肤和软组织感染，14±3.2 天。受访者建议金黄色葡萄球菌的治疗时间最长，凝固酶阴性葡萄球菌的治疗时间最短。大多数受访者不会根据宿主特征或临床反应措施来改变持续时间。ID 医生为所有五种综合征推荐的持续时间均长于重症监护医生，但大多数专家群体都将患者纳入 7 天与 14 天抗生素治疗的随机试验。总之，在菌血症抗生素治疗持续时间的建议方面，临床医生的实践存在显著差异。对于大多数菌血症综合征和病原体，短疗程与长疗程抗生素的随机试验存在平衡。
