| Title: |
Seven vs Fourteen Days of Antibiotics for Gram-Negative Bloodstream Infection: A Systematic Review and Noninferiority Meta-Analysis |
| Authors: |
Lee, Todd C.; Prosty, Connor J.; Fralick, Michael; Huttner, Angela; McDonald, Emily G.; Molina, José; Paul, Mical; Pinto, Ruxandra; Rishu, Asgar; Dach, Elodie von; Yahav, Dafna; Fowler, Rob; Daneman, Nick |
| Contributors: |
Consejo Superior de Investigaciones Científicas https://ror.org/02gfc7t72 |
| Publisher Information: |
American Medical Association |
| Publication Year: |
2025 |
| Collection: |
Digital.CSIC (Consejo Superior de Investigaciones Científicas / Spanish National Research Council) |
| Description: |
[Importance] Gram-negative bloodstream infections are a common cause of hospitalization. A 2-week duration of antibiotic therapy has been commonly used, but shorter durations may have similar outcomes. ; [Objectives] To assess whether 7 days of antibiotic therapy was noninferior to 14 days. ; [Data Sources] Starting with a 2022 individual patient data meta-analysis, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched to identify additional eligible randomized clinical trials (RCTs) conducted from May 1, 2022, until November 30, 2024. ; [Study Selection] RCTs involving primarily adults who were hospitalized at the time of Gram-negative bloodstream infection and were allocated to 7 or 14 days of antibiotic therapy. Studies were independently reviewed by 2 investigators. ; [Data Extraction and Synthesis] PRISMA guidelines were followed. Data were extracted by 2 investigators. Any unpublished data were obtained directly from study authors. Risk of bias and certainty of the evidence were assessed in duplicate using the Cochrane Risk of Bias Tool, version 2, and the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled by separate random-effects meta-analyses for the intention-to-treat (ITT) and per-protocol (PP) populations. A noninformative prior probability was used for the effect, and an evidence-based weakly informative prior probability was used for heterogeneity. Risk ratios (RRs), 95% credible intervals (CrIs), and probability of noninferiority were calculated using a prespecified upper bound of 1.25 or less. ; [Main Outcomes and Measures] Ninety-day all-cause mortality. ; [Results] Four eligible RCTs contributed 3729 patients in the ITT population (1912 women [51.3%]; median age range, 67-79 years) and 3126 in the PP population. In the ITT analysis, within 90 days, 226 patients (12.0%) receiving 7 days of antibiotics died compared with 253 (13.7%) receiving 14 days, corresponding to an RR for 90-day mortality of 0.91 (95% CrI, ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
40116824 |
| Relation: |
The underlying dataset has been published as supplementary material of the article in the publisher platform at DOI http://dx.doi.org/10.1001/jamanetworkopen.2025.1421; http://dx.doi.org/10.1001/jamanetworkopen.2025.1421; Sí; Jama Network Open 8(3): e251421 (2025); https://hdl.handle.net/10261/390467; https://api.elsevier.com/content/abstract/scopus_id/105001754556 |
| DOI: |
10.1001/jamanetworkopen.2025.1421 |
| Availability: |
https://hdl.handle.net/10261/390467; https://doi.org/10.1001/jamanetworkopen.2025.1421; https://api.elsevier.com/content/abstract/scopus_id/105001754556 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.97CB36F8 |
| Database: |
BASE |