Park Sun Hee, Milstone Aaron M, Diener-West Marie, Nussenblatt Veronique, Cosgrove Sara E, Tamma Pranita D
Division of Infectious Diseases, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Antimicrob Chemother. 2014 Mar;69(3):779-85. doi: 10.1093/jac/dkt424. Epub 2013 Oct 24.
The optimal duration of antibiotic therapy for uncomplicated Gram-negative bacteraemia remains undefined. Our objective was to compare clinical outcomes of receiving short (7-10 days) versus prolonged (>10 days) durations of antibiotic therapy for children with uncomplicated Gram-negative bacteraemia.
We conducted a retrospective cohort study of children with uncomplicated Gram-negative bacteraemia at The Johns Hopkins Hospital between 2002 and 2012. We estimated the risk of bacteraemic relapse among children who received short versus prolonged durations of antibiotic therapy using 1:1 nearest neighbour propensity score matching without replacement prior to performing regression analysis.
There were 170 matched pairs that were well balanced on baseline covariates. The median duration of therapy in the short and prolonged courses was 10 days (IQR 10-10) and 14 days (IQR 14-17), respectively. The 30 day mortality was similar between the groups (OR 1.12; 95% CI 0.96-1.21). A prolonged duration of antibiotic therapy did not reduce the relapse risk compared with shorter durations (adjusted hazard ratio 0.67; 95% CI 0.35-1.27). Similarly, each additional day of antibiotic therapy was not protective against relapse risk (adjusted hazard ratio 0.99 per additional day; 95% CI 0.92-1.03). There was a trend towards an increased subsequent risk of candidaemia in children receiving longer treatment durations (hazard ratio 2.44; 95% CI 0.97-6.19).
Antibiotic treatment for more than 10 days for uncomplicated bacteraemia in children does not reduce the risk of microbiological relapse compared with shorter-course therapy, but may be associated with an increased risk of candidaemia. Our findings need to be confirmed in a larger, prospective study.
单纯性革兰阴性菌血症的最佳抗生素治疗疗程仍不明确。我们的目的是比较单纯性革兰阴性菌血症患儿接受短疗程（7 - 10天）与长疗程（>10天）抗生素治疗的临床结局。
我们对2002年至2012年在约翰霍普金斯医院的单纯性革兰阴性菌血症患儿进行了一项回顾性队列研究。在进行回归分析之前，我们使用1:1最近邻倾向评分匹配且无替换的方法，估计接受短疗程与长疗程抗生素治疗的患儿中菌血症复发的风险。
有170对匹配对，在基线协变量上平衡良好。短疗程和长疗程治疗的中位时间分别为10天（四分位间距10 - 10）和14天（四分位间距14 - 17）。两组间30天死亡率相似（比值比1.12；95%置信区间0.96 - 1.21）。与短疗程相比，延长抗生素治疗疗程并未降低复发风险（调整后风险比0.67；95%置信区间0.35 - 1.27）。同样，抗生素治疗每增加一天对复发风险并无保护作用（每增加一天调整后风险比0.99；95%置信区间0.92 - 1.03）。接受较长治疗疗程的患儿随后发生念珠菌血症的风险有增加趋势（风险比2.44；95%置信区间0.97 - 6.19）。
与短疗程治疗相比，儿童单纯性菌血症使用抗生素治疗超过10天并不能降低微生物学复发风险，但可能与念珠菌血症风险增加有关。我们的研究结果需要在更大规模的前瞻性研究中得到证实。
