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Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm

  • 期刊论文

  • 发表日期：

    2024年7月3日

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  • Fabián Herrera,
  • Diego Torres,
  • Ana Laborde,
  • Rosana Jordán,
  • Lucas Tula,
  • Noelia Mañez,
  • María Laura Pereyra,
  • Nadia Suchowiercha,
  • Lorena Berruezo,
  • Carlota Gudiol,
  • María Luz González Ibáñez,
  • María José Eusebio,
  • Sandra Lambert,
  • Laura Barcán,
  • Inés Roccia Rossi,
  • Federico Nicola,
  • Magdalena Pennini,
  • Renata Monge,
  • Miriam Blanco,
  • Mariángeles Visús,
  • Mariana Reynaldi,
  • Ruth Carbone,
  • Fernando Pasterán,
  • Alejandra Corso,
  • Melina Rapoport,
  • Alberto Angel Carena,
  • Valeria Melia,
  • Patricia Costantini,
  • Martín Luck,
  • Marcelo Bronzi,
  • Andrea Nenna,
  • María Laura Chaves,
  • José Benso,
  • Verónica Fernández,
  • Viviana Vilches,
  • Fernando Poletta

摘要

Purpose

Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14 days.

Methods

This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7 days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14 days of AT.

Results

Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9 days (IQR: 7–15) vs. 14 days (IQR: 13–22) (p =  < 0.001).

Conclusions

These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.