Babich Tanya, Naucler Pontus, Valik John Karlsson, Giske Christian G, Benito Natividad, Cardona Ruben, Rivera Alba, Pulcini Celine, Fattah Manal Abdel, Haquin Justine, Macgowan Alasdair, Grier Sally, Chazan Bibiana, Yanovskay Anna, Ami Ronen Ben, Landes Michal, Nesher Lior, Zaidman-Shimshovitz Adi, McCarthy Kate, Paterson David L, Tacconelli Evelina, Buhl Michael, Mauer Susanna, Rodríguez-Baño Jesús, de Cueto Marina, Oliver Antonio, de Gopegui Enrique Ruiz, Cano Angela, Machuca Isabel, Gozalo-Marguello Monica, Martinez-Martinez Luis, Gonzalez-Barbera Eva M, Alfaro Iris Gomez, Salavert Miguel, Beovic Bojana, Saje Andreja, Mueller-Premru Manica, Pagani Leonardo, Vitrat Virginie, Kofteridis Diamantis, Zacharioudaki Maria, Maraki Sofia, Weissman Yulia, Paul Mical, Dickstein Yaakov, Leibovici Leonard, Yahav Dafna
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Rabin Medical Center, Research Authority, Beilinson Hospital, Petah-Tikva, Israel.
Infect Dis Ther. 2022 Aug;11(4):1505-1519. doi: 10.1007/s40121-022-00657-1. Epub 2022 May 25.
There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course.
We present a retrospective multicenter study including patients with P. aeruginosa bacteremia during 2009-2015. We evaluated outcomes of patients treated with short (6-10 days) versus long (11-15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used.
We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group [median 13 days, interquartile range (IQR) 9-21 days, versus median 15 days, IQR 11-26 days, p = 0.002]. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome.
In this retrospective study, 6-10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.
对于铜绿假单胞菌血症的最佳抗生素治疗疗程，目前尚无共识。我们旨在评估短疗程抗生素治疗的影响。
我们开展了一项回顾性多中心研究，纳入了2009年至2015年期间患有铜绿假单胞菌血症的患者。我们评估了接受短疗程（6 - 10天）与长疗程（11 - 15天）抗生素治疗的患者的结局。主要结局是30天死亡率、菌血症复发和/或持续存在的综合指标。对主要结局进行了单因素分析以及逆概率处理加权（IPTW）调整的多因素分析。为避免不朽时间偏倚，采用了标志性方法。
我们纳入了657例患者；273例接受短疗程抗生素治疗，384例接受长疗程治疗。患者的基线特征无显著差异。长疗程治疗组中384例患者中有61例（16%）出现综合主要结局，而短疗程治疗组中273例患者中有32例（12%）出现该结局（p = 0.131）。死亡率分别占病例的41/384（11%）和25/273（9%）。短疗程组的住院时间显著更短[中位数13天，四分位数间距（IQR）9 - 21天，而长疗程组中位数为15天，IQR 11 - 26天，p = 0.002]。长疗程组中有10例患者因不良事件停止抗生素治疗，而短疗程组中无此类情况。在单因素和多因素分析中，治疗疗程与主要结局无关。
在这项回顾性研究中，对于铜绿假单胞菌血症，6 - 10天的抗生素疗程在生存和复发方面与更长疗程一样有效。较短疗程与住院时间缩短及药物停用减少相关。
