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Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections

BACKGROUND: Trials supporting shorter durations of antibiotic therapy for Gram-negative bloodstream infections (GN-BSI) have recently been published. However, adoption of these findings into practice is unclear given limited eligibility criteria and relatively large non-inferiority margins of these...

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Autores principales: Thaden, Joshua T., Tamma, Pranita D., Pan, Qing, Doi, Yohei, Daneman, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827556/
https://www.ncbi.nlm.nih.gov/pubmed/35156030
http://dx.doi.org/10.1093/jacamr/dlac005
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author Thaden, Joshua T.
Tamma, Pranita D.
Pan, Qing
Doi, Yohei
Daneman, Nick
author_facet Thaden, Joshua T.
Tamma, Pranita D.
Pan, Qing
Doi, Yohei
Daneman, Nick
author_sort Thaden, Joshua T.
collection PubMed
description BACKGROUND: Trials supporting shorter durations of antibiotic therapy for Gram-negative bloodstream infections (GN-BSI) have recently been published. However, adoption of these findings into practice is unclear given limited eligibility criteria and relatively large non-inferiority margins of these studies. To better understand contemporary management of GN-BSI, we conducted an international survey of infectious diseases (ID) specialists. METHODS: We developed and disseminated an online survey to assess practice patterns involving treatment duration of GN-BSI, including providers from 28 countries. χ(2) tests, t-tests and multivariable linear regression with generalized estimating equations were used to identify factors associated with treatment duration. RESULTS: In total, 277 ID specialists completed the survey (64% physicians, 31% pharmacists). The median reported duration of antibiotics was 7 days (IQR, 7–10 days) for all GN-BSI sources. Thirty percent of providers typically recommend durations that differ by ≥7 days depending on the source of GN-BSI, and 71% treat ≥10 days for at least one source. In an adjusted model, factors associated with increased duration included intra-abdominal (+1.01 days, 95% CI 0.57–1.45 days; P < 0.0001), vascular catheter (+0.74 days; 0.33–1.15 days; P = 0.0004), and respiratory (+0.76 days; 0.38–1.14 days; P < 0.0001) sources of GN-BSI relative to urinary sources. Providers that transition patients to oral therapy report shorter durations than those who treat with full IV therapy (−0.60 days; −1.12 to −0.09 days; P = 0.02). CONCLUSIONS: There is extensive heterogeneity in duration of therapy for treating GN-BSI, particularly with respect to source of GN-BSI. Investigations into appropriate treatment durations for different GN-BSI sources are needed.
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spelling pubmed-88275562022-02-10 Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections Thaden, Joshua T. Tamma, Pranita D. Pan, Qing Doi, Yohei Daneman, Nick JAC Antimicrob Resist Original Article BACKGROUND: Trials supporting shorter durations of antibiotic therapy for Gram-negative bloodstream infections (GN-BSI) have recently been published. However, adoption of these findings into practice is unclear given limited eligibility criteria and relatively large non-inferiority margins of these studies. To better understand contemporary management of GN-BSI, we conducted an international survey of infectious diseases (ID) specialists. METHODS: We developed and disseminated an online survey to assess practice patterns involving treatment duration of GN-BSI, including providers from 28 countries. χ(2) tests, t-tests and multivariable linear regression with generalized estimating equations were used to identify factors associated with treatment duration. RESULTS: In total, 277 ID specialists completed the survey (64% physicians, 31% pharmacists). The median reported duration of antibiotics was 7 days (IQR, 7–10 days) for all GN-BSI sources. Thirty percent of providers typically recommend durations that differ by ≥7 days depending on the source of GN-BSI, and 71% treat ≥10 days for at least one source. In an adjusted model, factors associated with increased duration included intra-abdominal (+1.01 days, 95% CI 0.57–1.45 days; P < 0.0001), vascular catheter (+0.74 days; 0.33–1.15 days; P = 0.0004), and respiratory (+0.76 days; 0.38–1.14 days; P < 0.0001) sources of GN-BSI relative to urinary sources. Providers that transition patients to oral therapy report shorter durations than those who treat with full IV therapy (−0.60 days; −1.12 to −0.09 days; P = 0.02). CONCLUSIONS: There is extensive heterogeneity in duration of therapy for treating GN-BSI, particularly with respect to source of GN-BSI. Investigations into appropriate treatment durations for different GN-BSI sources are needed. Oxford University Press 2022-02-09 /pmc/articles/PMC8827556/ /pubmed/35156030 http://dx.doi.org/10.1093/jacamr/dlac005 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Thaden, Joshua T.
Tamma, Pranita D.
Pan, Qing
Doi, Yohei
Daneman, Nick
Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title_full Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title_fullStr Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title_full_unstemmed Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title_short Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections
title_sort survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of gram-negative bloodstream infections
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827556/
https://www.ncbi.nlm.nih.gov/pubmed/35156030
http://dx.doi.org/10.1093/jacamr/dlac005
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