657. Short-Course vs. Long-Course Antibiotic Therapy for Uncomplicated Enterococcal Bacteremia

TL;DR

This study found that short antibiotic treatment (4-10 days) for uncomplicated enterococcal bacteremia is as effective as longer treatment (11-17 days) with fewer hospital days.

Contribution

Demonstrated non-inferiority of short-course antibiotic therapy for uncomplicated enterococcal bacteremia.

Findings

Short-course therapy had non-inferior 30-day mortality compared to long-course therapy.

Short-course therapy reduced hospital length of stay and increased antibiotic-free days.

No significant differences in clinical cure or relapse rates between the two groups.

Abstract

The optimal duration of treatment for uncomplicated enterococcal bacteremia remains undefined. The 2009 Infectious Diseases Society of America (IDSA) recommends 7 to 14 days of treatment for central-line associated enterococcal bacteremia. We aimed to compare the outcomes of short-course antibiotic therapy (4-10 days) versus long-course therapy (11-17 days) in patients with uncomplicated enterococcal bacteremia.

A retrospective study was conducted on adults treated for uncomplicated enterococcal bacteremia between January 1st, 2021 and December 31st, 2024 across four acute-care hospitals in Miami, Florida. Uncomplicated enterococcal bacteremia was defined as having a monomicrobial positive blood culture with Enterococcus sp., along with clinical stability and microbiological clearance within 72 hours following treatment. Persistent bacteremia, lack of source control, and deep-seated infections were excluded. The primary outcome was 30-day mortality and secondary outcomes included clinical cure, 30-day microbiological relapse, antibiotic-free days, hospital length-of-stay, 90-day Clostridium difficile rate, and 30-day hospital readmission rate. A sample size of 276 patients was needed to achieve 80% power and a non-inferiority margin was set at 10%.

Of the 1,140 patients screened, 276 patients were included: 127 (46%) patients in short-course treatment and 149 (54%) patients in long-course treatment. The primary outcome of 30-day all-cause mortality occurred in 7 patients (5.5%) in the short-course group vs 6 patients (4.0%) in the long-course group ([risk difference, -1.49% [95% confidence interval, –6.50% to 3.53%]). No significant differences were observed in clinical cure, microbiological relapse, hospital readmission, and Clostridium difficile infections. Short-course compared to long-course therapy had reduced hospital length of stay (16 vs. 21 days; p< 0.03) and increased antibiotic-free days (18 vs. 13 days; p< 0.00001); step-down from intravenous to oral therapy occurred at a median of 4 and 5 days, respectively.

Among hospitalized patients with uncomplicated enterococcal bacteremia, antibiotic treatment with short-course therapy was noninferior to treatment with long-course therapy.

All Authors: No reported disclosures

Figures