Survey of infectious diseases providers reveals variability in duration of antibiotic therapy for the treatment of Gram-negative bloodstream infections

Abstract

Background: Trials supporting shorter durations of antibiotic therapy for Gram-negative bloodstream infections (GN-BSI) have recently been published. However, adoption of these findings into practice is unclear given limited eligibility criteria and relatively large non-inferiority margins of these studies. To better understand contemporary management of GN-BSI, we conducted an international survey of infectious diseases (ID) specialists. Methods: We developed and disseminated an online survey to assess practice patterns involving treatment duration of GN-BSI, including providers from 28 countries. χ2 tests, t-tests and multivariable linear regression with generalized estimating equations were used to identify factors associated with treatment duration. Results: In total, 277 ID specialists completed the survey (64% physicians, 31% pharmacists). The median reported duration of antibiotics was 7 days (IQR, 7-10 days) for all GN-BSI sources. Thirty percent of providers typically recommend durations that differ by ≥7 days depending on the source of GN-BSI, and 71% treat ≥10 days for at least one source. In an adjusted model, factors associated with increased duration included intra-abdominal (+1.01 days, 95% CI 0.57-1.45 days; P<0.0001), vascular catheter (+0.74 days; 0.33-1.15 days; P=0.0004), and respiratory (+0.76 days; 0.38-1.14 days; P<0.0001) sources of GN-BSI relative to urinary sources. Providers that transition patients to oral therapy report shorter durations than those who treat with full IV therapy (-0.60 days; -1.12 to -0.09 days; P=0.02). Conclusions: There is extensive heterogeneity in duration of therapy for treating GN-BSI, particularly with respect to source of GN-BSI. Investigations into appropriate treatment durations for different GN-BSI sources are needed.