No Need to Have Duration CREep Up

Reviewed by Sara Karaba, MD, PhD, MHS, Johns Hopkins University

In a multicenter, retrospective, propensity-score weighted cohort of patients with carbapenem-resistant Enterobacterales (CRE) bacteremia there was no difference in 30-day mortality or recurrent bacteremia between those that received short (7-10 days) vs prolonged (14-21 days) courses of active therapy. Of the 183 patients included in this study, 90% of patients had adequate source control, 35% of isolates had a carbapenemase gene (all blaKPC), and the most common treatment regimens included: ceftazidime-avibactam (41%), meropenem-vaborbactam (11%), and high-dose extended-infusion meropenem with or without an aminoglycoside, fluoroquinolone, or polymyxin (49%). In attempts to minimize biases, the authors employed inverse probability of treatment weighting (confounding by indication), required patients had to survive at least 1 day after antibiotics discontinued (immortal time bias), and patients had to receive active antibiotics within 72 hours and for at least 7 days. Similar to other studies of Gram-negative bacteremia, this study suggests that shorter courses (7-10 days) are sufficient for the treatment of CRE bacteremia with adequate source control.

Reference: Soto CL, Hsu AJ, Lee JH, et al. Identifying Effective Durations of Antibiotic Therapy for the Treatment of Carbapenem-resistant Enterobacterales Bloodstream Infections: A Multicenter Observational Study. Clin Infect Dis 2024; 78:27–30. doi:10.1093/cid/ciad476.

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