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Seven days of antibiotics for UTI-related BSI, but dose wisely

Reviewed by Erica Stohs, MD, MPH, University of Nebraska 

In an observational study of over 1000 adults with bloodstream infections due to complicated urinary tract infection in 24 diverse U.S. hospitals, investigators found that seven days of therapy is effective in in preventing recurrence so long as IV or highly bioavailable, appropriately dosed oral antibiotics are utilized.

Complicated UTI was defined as UTIs due to structural of functional abnormalities of the genitourinary tract or any UTI in a male patient. To avoid asymptomatic bacteriuria, investigators included bacteremia in the inclusion criteria. The primary outcome was recurrent infection from the same bacterial species within 30 days of completing therapy.  Investigators compared 7-day (n=265), 10-day (n=382), and 14-day (n=452) treatment courses.

There was no difference in odds of recurrent infection in 10-vs 14-day treatment and increased odds of recurrence (absolute odds ratio of 2.5) in 7-d vs 14-day, which was significant. However, when limiting 7- vs 14-day analysis to 627 pts who transitioned from IV-to-highly bioavailable oral agents (largely quinolones), the differences in outcomes NO LONGER persisted. Notably, use of highly bioavailable oral beta-lactams was poor, only 4%, highlighting an educational need when adopting such IV-to-PO transition. In the 76 patients with recurrent infection, 14 had drug-resistant infections. In such an observational trial, the reader must acknowledge confounding by treatment group.

Reference:
McAteer J et al. Defining the optimal duration of therapy for hospitalized patients with complicated urinary tract infections and associated bacteremia. CID 2023; 76 (9):1604-1612. https://doi.org/10.1093/cid/ciad009

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