Duration of antibiotic treatment for sepsis is due to the enterobacteriaceae family of bacteria

(Posts are updated on Uptodate in January 2019)

Sepsis is still the main cause of morbidity and mortality even though doctors have used antibiotic treatment regimens and modern care support. Gram-negative bacillus sepsis is a major problem in both hospital- or home-based patients. The rate of multidrug resistance of these microorganisms is increasing, making it difficult to treat. Gram-negative bacilli infections with shock have mortality between 12% and 38%; Mortality rates vary depending on whether the patient is on timely and appropriate antibiotic treatment.

UptoDate recently updated its recommendation based on a new study of the duration of antibiotic therapy for Enterobacteriaceae sepsis in January 2019.

The duration of treatment should be determined by the source of the primary infection, the degree of infection and the degree of clinical response of the patient. In most cases, the duration of treatment with antibiotics is 7 to 14 days. For patients with less complicated Enterobacteriaceae sepsis (that is, no intravascular, bone, joint or central nervous system infection, no uncontrolled source of infection, no impairment significantly reduced immunity), while responding well to antibiotic therapy and clinical improvement within 48 to 72 hours, UptoDate recommends a 7-day rather than 14-day regimen. Intravenous antibiotics should be used at first, but once the patient is safe and has remained free of fever within 48 hours, an oral antibiotic with in vitro active and bioavailability can be switched. good.

For less complicated Enterobacteriacae sepsis, the shorter antibiotic treatment times are as effective as long treatment regimens, and in turn reduces the selective pressure on antibiotic-resistant bacteria. In a randomized controlled study of 604 hospitalized patients with less complicated, less complex, fever-free gram-negative infections and hemodynamic stability for at least 48 hours, antibiotic treatment for 7 days versus 14 days resulted in Equivalent outcomes included all-cause mortality, recurrence, severe or distant complications, re-hospitalization or prolonged hospitalization after 90 days (46 vs. 48%; risk difference -2.6%, 95% confidence interval, -10.5 to 5.3%). [first]

Mortality rates at days 14 and 28 were also not statistically different between the two groups (2.3 and 5 versus 1.3 and 4.4%). The majority of patients with primary infection were urinary tract infection (68%) and infection Enterobacteriaceae (90%); 18% accidentally infected multi-drug resistant bacteria. In each group, nearly 10% of patients developed a new drug-resistant infection.

Similarly, in a study of more than 700 patients with sepsis caused by 1 type of Enterobacteriaceae, a shorter treatment duration (6 to 10 days) was found to have a mortality rate when analyzing the trend. mortality, recurrent infection and Clostridioides (formerly Clostridium) difficile were comparable to a longer treatment regimen (11 to 16 days) [2]. Using shorter treatment regimens tends to decrease the risk of recurrent infections of the multiresistant gram-negative bacilli and recurrent colonization.

Source:

[1] Yahav D, Franceschini E, Koppel F, et al. Seven versus fourteen Days of Antibiotic Therapy for uncomplicated Gram-negative Bacteremia: a Non-inferiority Randomized Controlled Trial. Clin Infect Dis 2018.

[2] Chotiprasitsakul D, Han JH, Cosgrove SE, et al. Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort. Clin Infect Dis 2018; 66:172.

www.uptodate.com