{"id":5480,"date":"2024-07-01T09:45:51","date_gmt":"2024-07-01T13:45:51","guid":{"rendered":"https:\/\/www.med.unc.edu\/casp\/?p=5480"},"modified":"2024-10-01T11:28:14","modified_gmt":"2024-10-01T15:28:14","slug":"evaluating-antibiotic-durations-of-therapy-for-uncomplicated-gram-negative-bacteremia-from-urinary-sources","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/casp\/2024\/07\/evaluating-antibiotic-durations-of-therapy-for-uncomplicated-gram-negative-bacteremia-from-urinary-sources\/","title":{"rendered":"Evaluating Antibiotic Durations of Therapy for Uncomplicated Gram-Negative Bacteremia from Urinary Sources"},"content":{"rendered":"<p>A 2019 randomized controlled trial demonstrated noninferiority amongst patients treated with seven versus 14 days of antibiotics for uncomplicated bacteremia caused by Gram-negative organisms. The primary composite outcome, including all-cause mortality, infectious complications, and hospital readmissions, occurred in 46% of patients in the seven-day group vs 48% in the 14-day group. Most of the 600 study patients in this trial had infections caused by Enterobacterales organisms such as <em>E. coli<\/em> from a urinary source and were transitioned to an oral fluoroquinolone for step-down therapy. The study concluded that reducing antibiotic treatment durations for uncomplicated Gram-negative bacteremia to seven days was non-inferior to longer durations and represented an important antibiotic stewardship intervention (Yahav et al., 2019).<\/p>\n<p>Trial results informed the Carolina Antibiotic Stewardship Program\u2019s (CASP) <a href=\"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2023\/05\/Duration-of-Antibiotic-Therapy.pdf\">Best Practices for Duration of Antimicrobial Therapy<\/a> were updated to recommend a seven-day duration for treatment of pyelonephritis with bacteremia caused by <em>Enterobacterales<\/em> organisms such as <em>E. coli<\/em>. Clinical scenarios such as complicated bacteremias with sequelae of infection or the presence of infected renal stones or foreign material may require treatment durations beyond seven days.<\/p>\n<p>In 2023, CASP conducted a study led by Ashley Marx, PharmD, and Stephanie Hill, PharmD, to assess the median treatment durations for patients hospitalized at the University of North Carolina Hospitals with <em>E. coli <\/em>bacteremia from a urinary source in 2022. Adult patients 18 years or older were included if they had positive blood cultures for <em>E. coli <\/em>with a diagnosis of UTI, pyelonephritis, or positive urine culture during the admission. Immunocompromised patients were excluded. A total of 64 patients met the inclusion criteria, of which 70% were females with a median age of 64 years and a median length of hospital admission of six days. Some 18% of patients required ICU-level care during their admission.<\/p>\n<p>Approximately one-third of patients completed their treatment course with intravenously administered antibiotics, and the remaining two-thirds received a combination of intravenous and oral antibiotics. The most common oral step-down agents included fluoroquinolones (72%), \u03b2-lactams (23%), or trimethoprim-sulfamethoxazole (5%). A subgroup analysis of 31 patients with uncomplicated bacteremia found the median antibiotic treatment duration for uncomplicated <em>E. coli<\/em> bacteremia from a urinary source was ten days (IQR: 8-12; range 7-17). Findings from this study will serve as a duration of antimicrobial therapy baseline for future opportunities to optimize treatment durations for uncomplicated Gram-negative bacteremia.<\/p>\n<p>&nbsp;<\/p>\n<p><em>Stephanie Hill, PharmD is a PGY2 with UNC Hospitals. <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 2019 randomized controlled trial demonstrated noninferiority amongst patients treated with seven versus 14 days of antibiotics for uncomplicated bacteremia caused by Gram-negative organisms. The primary composite outcome, including all-cause mortality, infectious complications, and hospital readmissions, occurred in 46% of patients in the seven-day group vs 48% in the 14-day group. Most of the 600 &hellip; <a href=\"https:\/\/www.med.unc.edu\/casp\/2024\/07\/evaluating-antibiotic-durations-of-therapy-for-uncomplicated-gram-negative-bacteremia-from-urinary-sources\/\" aria-label=\"Read more about Evaluating Antibiotic Durations of Therapy for Uncomplicated Gram-Negative Bacteremia from Urinary Sources\">Read more<\/a><\/p>\n","protected":false},"author":103756,"featured_media":5482,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[4],"tags":[],"class_list":["post-5480","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","odd"],"acf":[],"featured_image":"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2024\/07\/gram-negative-bacteria.jpg","featured_image_medium":"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2024\/07\/gram-negative-bacteria-300x169.jpg","featured_image_medium_large":"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2024\/07\/gram-negative-bacteria-768x432.jpg","featured_image_large":"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2024\/07\/gram-negative-bacteria-1024x576.jpg","featured_image_thumbnail":"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2024\/07\/gram-negative-bacteria-150x150.jpg","featured_image_alt":"Gram-negative bacteria under microscope with pink background","category_details":[{"name":"News","link":"https:\/\/www.med.unc.edu\/casp\/category\/news\/"}],"tag_details":[],"_links_to":[],"_links_to_target":[],"_links":{"self":[{"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/posts\/5480","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/users\/103756"}],"replies":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/comments?post=5480"}],"version-history":[{"count":0,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/posts\/5480\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/media\/5482"}],"wp:attachment":[{"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/media?parent=5480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/categories?post=5480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.med.unc.edu\/casp\/wp-json\/wp\/v2\/tags?post=5480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}