P-36. Evaluating outcomes for short (≤ 10 days) versus long (> 10 days) duration of therapy for Gram-negative bacteremia in kidney transplant recipients

TL;DR

The study compares short and long antibiotic treatments for Gram-negative infections in kidney transplant patients, finding similar outcomes with shorter courses.

Contribution

This study is one of the first to evaluate short versus long antibiotic duration specifically in kidney transplant recipients with Gram-negative bacteremia.

Findings

Shorter antibiotic duration (≤ 10 days) showed similar 90-day mortality and relapse rates compared to longer courses (> 10 days).

Transitioning to oral antibiotics was associated with lower 90-day mortality or relapse rates compared to continued intravenous antibiotics.

Abstract

Gram-negative bacteremia in solid organ transplants is a common complication and has been associated with morbidity and mortality. Despite the shift to shorter durations of therapy for Gram-negative bacteremia in recent literature, the question of duration for Gram-negative bacteremia in kidney transplant recipients (KTR) remains.Figure 1:EnrollmentTable 1:Baseline characteristics

Enrollment

Baseline characteristics

This IRB exempt, retrospective observational chart review evaluated adult KTRs with Gram-negative bacteremia who received therapy for ≤ 10 days vs. > 10 days between January 2016 to June 2024. Patients were included if they received active antibiotics for at least 5 days. Patients were excluded if they had a polymicrobial bacteremia, bacteremia secondary to infections requiring prolonged antibiotics, concomitant infection requiring antibiotics at the time of diagnosis of the Gram-negative bacteremia, uncontrolled source of infection, or history of multiorgan transplant. The primary outcome is a composite of 90-day mortality or microbiologic relapse. Secondary outcomes include a composite of 30-day mortality or relapse, hospital length of stay (LOS), development of multi-drug resistant (MDR) bacteria, and transplant rejection. We performed a subgroup analysis of our 90-day composite outcome in those transitioned to oral (PO) vs. continued intravenous (IV) antibiotics.Figure 2:Source of infectionTable 2:Primary and secondary outcomes*Excluded patients that could not be assessed

Source of infection

Primary and secondary outcomes

*Excluded patients that could not be assessed

A total of 72 patients were included in the study. Sixteen patients received ≤ 10 days and 56 received > 10 days of antibiotics with a mean duration of 9 and 14 days respectively. The primary composite of 90-day mortality or relapse of bacteremia was not statistically significant at 12.5% in the ≤ 10-day group and 11% in the > 10-day group. There were no statistically significant differences in any secondary outcomes. In our subgroup analysis, patients remaining on IV antibiotics had higher rates of 90-day mortality or relapse at 14.3% vs. 2.3% in those transitioned to PO antibiotics (p = 0.0085).

This study demonstrates that prescribing patterns for treatment of Gram-negative bacteremia in KTRs vary. Those who received ≤ 10 days had similar outcomes compared to those who received > 10 days. Shorter courses may be adequate for Gram-negative bacteremia in KTRs, however larger studies are required to confirm these results.

All Authors: No reported disclosures

Figures