Liu Ming, Gao Ya, Zheng Li, Li Zhifan, Yao Liang, Xu Jianguo, Zheng Qingyong, Zeng Ping, Tian Jinhui
Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 308232, Singapore.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
EClinicalMedicine. 2025 Jul 31;86:103397. doi: 10.1016/j.eclinm.2025.103397. eCollection 2025 Aug.
The optimal duration of antibiotic treatment for bloodstream infections remains uncertain. This study aimed to compare the efficacy and safety of shorter versus longer duration antibiotic treatment for immunocompetent patients with bloodstream infections.
We searched Medline, Embase, and Cochrane Central Register of Controlled Trials without language restrictions for randomized controlled trials (RCTs) published between database inception and 25 November 2024, comparing shorter-duration antibiotic treatments with longer-duration antibiotic treatments in patients with bloodstream infections with a minimum difference of 3 days in duration of therapy. We employed random-effects meta-analyses to summarize the evidence. We used the mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes. For dichotomous outcomes, we used the odds ratios (ORs) or risk ratios (RRs) with 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of evidence. This study is registered with Open Science Framework (https://osf.io/egs8q).
Eleven RCTs published between 2006 and 2025, involving a total of 5505 participants, proved eligible. There are probably little or no differences in mortality (RR 0.91, 95% CI 0.79-1.05; moderate certainty), treatment failure (RR 1.08, 95% CI 0.69-1.68; moderate certainty), and relapse rates (RR 1.15, 95% CI 0.82-1.63; moderate certainty) between shorter- and longer-duration antibiotics. Compared with longer-duration antibiotics, shorter-duration antibiotics do not increase hospital readmission (RR 0.91, 95% CI 0.75-1.1; high certainty), but reduce the length of hospital stay (MD -3.04, 95% CI -3.9 to -2.18; high certainty). With very low certainty evidence, we are uncertain whether shorter-duration antibiotics decrease any adverse events (RR 1.0, 95% CI 0.76-1.32) and serious adverse events (RR 0.67, 95% CI 0.39-1.14) compared with longer-duration antibiotics.
Shorter- and longer-duration antibiotics show similar efficacy for bloodstream infections, with shorter courses reducing hospital stay. Consistent effects were observed across age groups and bacterial types, but cautious interpretation is needed due to limited subgroup data.
None.
血流感染抗生素治疗的最佳疗程仍不确定。本研究旨在比较免疫功能正常的血流感染患者接受较短疗程与较长疗程抗生素治疗的疗效和安全性。
我们检索了Medline、Embase和Cochrane对照试验中央注册库，不限语言，查找在数据库建立至2024年11月25日期间发表的随机对照试验（RCT），比较血流感染患者接受较短疗程与较长疗程抗生素治疗，治疗疗程至少相差3天。我们采用随机效应荟萃分析来总结证据。对于连续性结局，我们使用均数差（MD）及95%置信区间（CI）。对于二分结局，我们使用比值比（OR）或风险比（RR）及95%CI。我们使用推荐分级评估、制定和评价（GRADE）框架来评估证据的确定性。本研究已在开放科学框架（https://osf.io/egs8q）注册。
2006年至2025年期间发表的11项RCT符合纳入标准，共涉及5505名参与者。较短疗程与较长疗程抗生素治疗在死亡率（RR 0.91，95%CI 0.79 - 1.05；中等确定性）、治疗失败率（RR 1.08，95%CI 0.69 - 1.68；中等确定性）和复发率（RR 1.15，95%CI 0.82 - 1.63；中等确定性）方面可能几乎没有差异。与较长疗程抗生素相比，较短疗程抗生素不会增加再入院率（RR 0.91，95%CI 0.75 - 1.1；高确定性），但会缩短住院时间（MD -3.04，95%CI -3.9至-2.18；高确定性）。基于极低确定性的证据，我们不确定与较长疗程抗生素相比，较短疗程抗生素是否会减少任何不良事件（RR 1.0，95%CI 0.76 - 1.32）和严重不良事件（RR 0.67，95%CI 0.39 - 1.14）。
较短疗程和较长疗程抗生素对血流感染显示出相似的疗效，较短疗程可缩短住院时间。在各年龄组和细菌类型中均观察到一致的效果，但由于亚组数据有限，需要谨慎解读。
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