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Observational Study
. 2025 Mar;51(3):518-528.
doi: 10.1007/s00134-025-07857-6. Epub 2025 Apr 7.

Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database

Lena Gajdos  1   2 , Niccolo Buetti  2   3 , Alexis Tabah  4   5   6 , Stephane Ruckly  1   2 , Murat Akova  7 , Frederik Sjöval  8   9 , Kostoula Arvaniti  10 , Jan de Waele  11   12 , Hendrik Bracht  13 , Francois Barbier  14 , Jean-François Timsit  15   16   17 ; EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) and the OUTCOMEREA Network
Collaborators, Affiliations
Observational Study

Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database

Lena Gajdos et al. Intensive Care Med. 2025 Mar.

Erratum in

Abstract

Introduction: Hospital-acquired bloodstream infections (HA-BSIs) are severe and require antibiotic therapy. In non-complicated BSIs, shortened therapy reduces side effects without compromising efficacy. The impact of shortened antibiotic therapy in HA-BSI critically ill patients without indication of prolonged therapy requires further evaluation.

Methods: Using the international prospective EUROBACT-2 cohort, we compared shortened (7-10 days) versus long (14-21 days) treatment durations in ICU patients eligible for shortened therapy. Patients without antibiotic therapy within 3 days after HA-BSI occurrence or requiring prolonged therapy (due to infection source, microorganism, or clinical deterioration) were excluded. Treatment failure, defined as death, persistent infection, or subsequent infectious complications by Day 28, was assessed using an inverse-probability of treatment weighted (IPTW) logistic regression.

Results: Among 2600 patients, 550 were eligible for shortened treatment, 213 received short, and 337 received long treatment. The most common infection source was intravascular catheters (33%), most common microorganisms were Enterobacterales (39%). Patients with long treatment were more frequently infected with Staphylococcus aureus (11% vs. 5.6%, p = 0.025) or difficult-to-treat microorganisms (23% vs. 7%, p < 0.001), and received more commonly combination therapy (46% vs. 30%, p < 0.001). Short treatment was associated with reduced 28-day treatment failure (OR 0.64, 95% CI 0.44-0.93, p = 0.019), mainly due to reduction in subsequent infectious complications (OR 0.58, 95% CI 0.37-0.91, p = 0.018). Mortality (OR 0.92 [95% CI 0.59, 1.43], p = 0.7) and persistent infection rates (OR 0.47 [95% CI 0.17, 1.14], p = 0.12) were similar.

Conclusions: In selected ICU patients with HA-BSI, shortened antibiotic treatment might be considered. Eurobact2 was a prospective international cohort study, registered in ClinicalTrials.org (NCT03937245).

Keywords: Antibiotic therapy duration; Critically ill; Hospital-acquired bloodstream infection.

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Conflict of interest statement

Declarations. Conflicts of interest: LG has nothing to disclose, NB has nothing to disclose, AT has nothing to disclose, SR has nothing to disclose, MA has nothing to disclose, FS has nothing to disclose, KA has nothing to disclose JJW has nothing to disclose, HB has nothing to disclose, FB reported consulting fees from Shionogi, lecture fees from MSD and Advanz Pharma, conference invitations from Pfizer, and research grants from MSD, JFT reported advisory boards participation for Merck, Gilead, Beckton-Dickinson, Pfizer, Menarini, Advanz, Paratek, research grants from Merck and Pfizer. Ethical approval and consent to participate: Initial ethical approval as a low-risk research project with waiver of individual consent was granted by the Human Research Ethics Committee of the Royal Brisbane & Women’s Hospital, Queensland, Australia (LNR/2019/ QRBW/48376). Each study site then obtained ethical and governance approvals according to national and/or local regulations.

References

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