Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study
Tanya Babich, Pontus Nauclér, John Karlsson Valik, Christian G. Giske, Natividad Benito, Ruben Cardona, Alba Rivera, Céline Pulcini, Manal Abdel Fattah, Justine Haquin, Alasdair MacGowan, Sally Grier, Bibiana Chazan, Anna Yanovskay, Ronen Ben‐Ami, Michal Landes, Lior Nesher, Adi Zaidman-Shimshovitz, Kate McCarthy, David L. Paterson, Evelina Tacconelli, Michael Buhl, Susanna Mauer, Jesús Rodríguez‐Baño, Marina de Cueto, Antonio Oliver, Enrique Ruíz de Gopegui, Ángela Cano, Isabel Machuca, Mónica Gozalo-Margüello, Luis Martı́nez-Martı́nez, Eva González, Iris Gomez Alfaro, Miguel Salavert, Bojana Beović, Andreja Saje, Manica Mueller‐Premru, Léonardo Pagani, Virginie Vitrat, Diamantis P. Kofteridis, Maria Zacharioudaki, Sofia Maraki, Yulia Weissman, Mical Paul, Yaakov Dickstein, Leonard Leibovici, Dafna Yahav
Abstract
INTRODUCTION: There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.