Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context
Summary: Background: The optimal duration of antibiotic treatment for bloodstream infections remains uncertain. This study aimed to compare the efficacy and safety of shorter versus longer duration antibiotic treatment for immunocompetent patients with bloodstream infections. Methods: We searched M...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025003293 |
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| author | Ming Liu Ya Gao Li Zheng Zhifan Li Liang Yao Jianguo Xu Qingyong Zheng Ping Zeng Jinhui Tian |
| author_facet | Ming Liu Ya Gao Li Zheng Zhifan Li Liang Yao Jianguo Xu Qingyong Zheng Ping Zeng Jinhui Tian |
| author_sort | Ming Liu |
| collection | DOAJ |
| description | Summary: Background: The optimal duration of antibiotic treatment for bloodstream infections remains uncertain. This study aimed to compare the efficacy and safety of shorter versus longer duration antibiotic treatment for immunocompetent patients with bloodstream infections. Methods: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials without language restrictions for randomized controlled trials (RCTs) published between database inception and 25 November 2024, comparing shorter-duration antibiotic treatments with longer-duration antibiotic treatments in patients with bloodstream infections with a minimum difference of 3 days in duration of therapy. We employed random-effects meta-analyses to summarize the evidence. We used the mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes. For dichotomous outcomes, we used the odds ratios (ORs) or risk ratios (RRs) with 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of evidence. This study is registered with Open Science Framework (https://osf.io/egs8q). Findings: Eleven RCTs published between 2006 and 2025, involving a total of 5505 participants, proved eligible. There are probably little or no differences in mortality (RR 0.91, 95% CI 0.79–1.05; moderate certainty), treatment failure (RR 1.08, 95% CI 0.69–1.68; moderate certainty), and relapse rates (RR 1.15, 95% CI 0.82–1.63; moderate certainty) between shorter- and longer-duration antibiotics. Compared with longer-duration antibiotics, shorter-duration antibiotics do not increase hospital readmission (RR 0.91, 95% CI 0.75–1.1; high certainty), but reduce the length of hospital stay (MD −3.04, 95% CI −3.9 to −2.18; high certainty). With very low certainty evidence, we are uncertain whether shorter-duration antibiotics decrease any adverse events (RR 1.0, 95% CI 0.76–1.32) and serious adverse events (RR 0.67, 95% CI 0.39–1.14) compared with longer-duration antibiotics. Interpretation: Shorter- and longer-duration antibiotics show similar efficacy for bloodstream infections, with shorter courses reducing hospital stay. Consistent effects were observed across age groups and bacterial types, but cautious interpretation is needed due to limited subgroup data. Funding: None. |
| format | Article |
| id | doaj-art-e5b6ad1614aa42bab5efde2cba4d246f |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-e5b6ad1614aa42bab5efde2cba4d246f2025-08-20T03:32:04ZengElsevierEClinicalMedicine2589-53702025-08-018610339710.1016/j.eclinm.2025.103397Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in contextMing Liu0Ya Gao1Li Zheng2Zhifan Li3Liang Yao4Jianguo Xu5Qingyong Zheng6Ping Zeng7Jinhui Tian8Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 308232, Singapore; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence-based Medicine of Gansu Province, Lanzhou, 730000, ChinaDepartment of Medical Data, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250100, China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250100, China; Corresponding author. Department of Medical Data, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan City, 250100, Shandong Province, China.Department of Pharmacy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, 100074, ChinaDepartment of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250031, ChinaLee Kong Chian School of Medicine, Nanyang Technological University Singapore, 308232, SingaporeEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Population Health Research Institute, Hamilton, L8N 3Z5, Canada; Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, L8S 4L8, CanadaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence-based Medicine of Gansu Province, Lanzhou, 730000, ChinaThe Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, 100730, China; Corresponding author. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China.Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence-based Medicine of Gansu Province, Lanzhou, 730000, China; Corresponding author. National Center of Gerontology of National Health Commission, Beijing Hospital, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.Summary: Background: The optimal duration of antibiotic treatment for bloodstream infections remains uncertain. This study aimed to compare the efficacy and safety of shorter versus longer duration antibiotic treatment for immunocompetent patients with bloodstream infections. Methods: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials without language restrictions for randomized controlled trials (RCTs) published between database inception and 25 November 2024, comparing shorter-duration antibiotic treatments with longer-duration antibiotic treatments in patients with bloodstream infections with a minimum difference of 3 days in duration of therapy. We employed random-effects meta-analyses to summarize the evidence. We used the mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes. For dichotomous outcomes, we used the odds ratios (ORs) or risk ratios (RRs) with 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of evidence. This study is registered with Open Science Framework (https://osf.io/egs8q). Findings: Eleven RCTs published between 2006 and 2025, involving a total of 5505 participants, proved eligible. There are probably little or no differences in mortality (RR 0.91, 95% CI 0.79–1.05; moderate certainty), treatment failure (RR 1.08, 95% CI 0.69–1.68; moderate certainty), and relapse rates (RR 1.15, 95% CI 0.82–1.63; moderate certainty) between shorter- and longer-duration antibiotics. Compared with longer-duration antibiotics, shorter-duration antibiotics do not increase hospital readmission (RR 0.91, 95% CI 0.75–1.1; high certainty), but reduce the length of hospital stay (MD −3.04, 95% CI −3.9 to −2.18; high certainty). With very low certainty evidence, we are uncertain whether shorter-duration antibiotics decrease any adverse events (RR 1.0, 95% CI 0.76–1.32) and serious adverse events (RR 0.67, 95% CI 0.39–1.14) compared with longer-duration antibiotics. Interpretation: Shorter- and longer-duration antibiotics show similar efficacy for bloodstream infections, with shorter courses reducing hospital stay. Consistent effects were observed across age groups and bacterial types, but cautious interpretation is needed due to limited subgroup data. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537025003293Shorter-duration antibioticLonger-duration antibioticBloodstream infectionsMeta-analysisGRADE |
| spellingShingle | Ming Liu Ya Gao Li Zheng Zhifan Li Liang Yao Jianguo Xu Qingyong Zheng Ping Zeng Jinhui Tian Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context EClinicalMedicine Shorter-duration antibiotic Longer-duration antibiotic Bloodstream infections Meta-analysis GRADE |
| title | Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context |
| title_full | Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context |
| title_fullStr | Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context |
| title_full_unstemmed | Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context |
| title_short | Shorter versus longer-duration antibiotic treatments for immunocompetent patients with bloodstream infections: a systematic review and meta-analysisResearch in context |
| title_sort | shorter versus longer duration antibiotic treatments for immunocompetent patients with bloodstream infections a systematic review and meta analysisresearch in context |
| topic | Shorter-duration antibiotic Longer-duration antibiotic Bloodstream infections Meta-analysis GRADE |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025003293 |
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