UNASSIGNED: Uncomplicated Staphylococcus aureus bacteremia remains a leading cause of morbidity and mortality in hospitalized patients. Current guidelines recommend a minimum of 14 days of treatment.
UNASSIGNED: To evaluate the efficacy and safety of short versus usual antibiotic therapy in adults with uncomplicated S. aureus bacteremia (SAB).
UNASSIGNED: We developed a search strategy to identify systematic review and meta-analysis of non-randomized studies (NRS), comparing short versus usual or long antibiotic regimens for uncomplicated SAB in MEDLINE, Embase, and the Cochrane Register up to June 2023. The risk of bias was assessed using the ROBINS I tool. The meta-analysis was performed using Review Manager software with a random effect model.
UNASSIGNED: Six NRS with a total of 1700 patients were included. No significant differences were found when comparing short versus prolonged antibiotic therapy as defined by the authors for 90-day mortality [odds ratio (OR): 1.09; 95% confidence interval (CI): 0.82-1.46, p: 0.55; I2 = 0%] or 90-day recurrence or relapse of bacteremia [OR: 0.72; 95% CI: 0.31-1.68, p: 0.45; I2 = 26%]. Sensitivity analysis showed similar results when comparing a predefined duration of <14 days versus ⩾14 days and when excluding the only study with a high risk of bias.
UNASSIGNED: Shorter-duration regimens could be considered as an alternative option for uncomplicated SAB in low-risk cases. However, based on a small number of studies with significant methodological limitations and risk of bias, the benefits and harms of shorter regimens should be analyzed with caution. Randomized clinical trials are needed to determine the best approach regarding the optimal duration of therapy.
Comparing short and regular antibiotic treatment duration, for a type of blood infection caused by S. aureus We investigated the optimal duration of antibiotic treatment for adults with a specific type of blood infection (uncomplicated Staphylococcus aureus), a condition with a significant global impact on mortality and costs. After a thorough search, only six trials involving 1700 patients were identified. We therefore decided to perform a meta-analysis (a type of statistical analysis). The results showed that the duration of antibiotics, whether short or long (less or more than 14 days), did not significantly affect mortality or recurrence of infection within 90 days. Consequently, we suggested that shorter courses of antibiotics might be appropriate for less severe cases. However, we emphasized caution because of the limitations of the studies. We recommended further research with improved methods to determine the optimal approach to treating this type of infection.

UNASSIGNED: We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations.
UNASSIGNED: We conducted a systematic review and meta-analysis of contemporary medical literature from 2000 to 2020, searching for studies of pyogenic liver abscesses. The primary outcome of interest was mean antibiotic treatment duration, which we pooled by random-effects meta-analysis. Meta-regression was performed to examine characteristics influencing antibiotic durations.
UNASSIGNED: Sixteen studies (of 3,933 patients) provided sufficient data on antibiotic durations for pooling in meta-analysis. Mean antibiotic durations were highly variable across studies, from 8.4 (SD 5.3) to 68.9 (SD 30.3) days. The pooled mean treatment duration was 32.7 days (95% CI 24.9 to 40.6), but heterogeneity was very high (I2 = 100%). In meta-regression, there was a non-significant trend towards decreased mean antibiotic treatment durations over later study years (-1.14 days/study year [95% CI -2.74 to 0.45], p = 0.16). Mean treatment duration was not associated with mean age of participants, percentage of infections caused by Klebsiella spp, percentage of patients with abscesses over 5 cm in diameter, percentage of patients with multiple abscesses, and percentage of patients receiving medical management. No randomized trials have compared treatment durations for pyogenic liver abscess, and no observational studies have reported outcomes according to treatment duration.
UNASSIGNED: Among studies reporting on antibiotic durations for pyogenic liver abscess, treatment practices are highly variable. This variability does not seem to be explained by differences in patient, pathogen, abscess, or management characteristics. Future RCTs are needed to guide optimal treatment duration for patients with this complex infection.
UNASSIGNED: Les chercheurs ont procédé à l’analyse systématique des recherches sur les abcès hépatiques pyogènes afin de découvrir les données sur la durée de l’antibiothérapie.
UNASSIGNED: Les chercheurs ont réalisé une analyse systématique et une méta-analyse des publications médicales parues entre 2000 et 2020 pour en extraire les études sur les abcès hépatiques pyogènes. Le résultat primaire était la durée moyenne de l’antibiothérapie, qu’ils ont regroupée par méta-analyse à effets aléatoires. Ils ont procédé à une méta-régression pour examiner les caractéristiques qui influent sur la durée de l’antibiothérapie.
UNASSIGNED: Seize études (auprès de 3 933 patients) contenaient assez de données sur la durée de l’antibiothérapie pour être regroupées dans la méta-analyse. La durée moyenne de l’antibiothérapie était très variable d’une étude à l’autre, de 8,4±5,3 à 68,9±30,3 jours. La durée moyenne du traitement regroupé était de 32,7 jours (IC à 95 %, 24,9 à 40,6 jours), mais l’hétérogénéité était très élevée (I2 = 100 %). La méta-régression a révélé une tendance non significative vers une durée moins longue de l’antibiothérapie moyenne pendant les dernières années de l’étude (−1,14 jour par année d’étude, IC à 95 %, −2,74+0,45, p = 0,16). La durée moyenne du traitement n’était pas associée à l’âge moyen des participants, au pourcentage d’infections causées par les espèces de Klebsiella, au pourcentage de patients ayant un abcès de plus de cinq centimètres de diamètre, au pourcentage de patients ayant de multiples abcès et au pourcentage de patients recevant une prise en charge médicale. Aucune étude randomisée n’avait comparé la durée du traitement de l’abcès hépatique pyogène, et aucune étude observationnelle n’avait rendu compte des résultats cliniques en fonction de la durée du traitement.
UNASSIGNED: Dans les études sur la durée de l’antibiothérapie des abcès hépatiques pyogènes, les pratiques thérapeutiques sont très variables. Cette variabilité ne semble pas s’expliquer par les différences entre les patients, les agents pathogènes, les abcès ou les caractéristiques de prise en charge. Des études randomisées et contrôlées devront être réalisées pour obtenir des indications quant à la durée optimale du traitement chez les patients atteints de cette infection complexe.

Background: Necrotizing soft tissue infections (NSTIs) are rapidly spreading, life-threatening infections that require emergent surgical intervention with immediate antibiotic initiation. However, there is no consensus regarding duration of antibiotic therapy after source control. We hypothesized that a short course of antibiotic therapy is as effective as a long course of antibiotic therapy after final debridement for NSTI. Methods: A systematic review of the literature was performed using PubMed, Embase, and Cochrane Library from inception to November 2022. Observational studies comparing short (≤7 days) versus long (>7 days) antibiotic duration for NSTI were included. Primary outcome was mortality and secondary outcomes included limb amputation and Clostridium difficile infection (CDI). Cumulative analysis was performed with Fisher exact test. Meta-analysis was performed using a fixed effects model and heterogeneity was assessed using Higgins I2. Results: A total of 622 titles were screened and four observational studies evaluating 532 patients met inclusion criteria. Mean age was 52 years, 67% were male, 61% had Fournier gangrene. There was no difference in mortality when comparing short to long duration antibiotic agents on both cumulative analysis (5.6% vs. 4.0%; p = 0.51) and meta-analysis (relative risk, 0.9; 95% confidence interval, 0.8-1.0; I2 0; p = 0.19). There was no significant difference in rates of limb amputation (11% vs. 8.5%; p = 0.50) or CDI (20.8% vs. 13.3%; p = 0.14). Conclusions: Short duration antibiotic therapy may be as effective as longer duration antibiotic therapy for NSTI after source control. Further high-quality data such as randomized clinical trials are required to create evidence-based guidelines.

UNASSIGNED: For ventilator-associated pneumonia (VAP), the safety of short-course versus long-course antibiotic therapy is still debated, especially regarding documented VAP due to non-fermenting Gram-negative bacilli (NF-GNB). The aim of this meta-analysis was to assess the rates of recurrence and relapse of VAP in patients receiving short-course (≤8 days) and long-course (≥10-15 days) of antibiotic therapy.
UNASSIGNED: The protocol for this study was registered in the PROSPERO database (ID: CRD42022365138). We performed an electronic search of the relevant literature and limited our search to data published from 2000 until September 1, 2022. We searched for randomized controlled trials (RCTs) in the United States National Library of Medicine, Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, National Institutes of Health PubMed/MEDLINE, web of science and Google Scholar databases. The primary endpoint was the recurrence and relapses of VAP, secondary endpoints were 28-day mortality, mechanical ventilation duration, number of extra-pulmonary infections and length of ICU stay.
UNASSIGNED: We identified five relevant studies involving 1069 patients (530 patients in the short-course group and 539 patients in the long-course group). The meta-analysis did not reveal any significant difference between short and long-course antibiotic therapy for recurrence and relapses of VAP (odd ratio \"OR\" = 1.48, 95% confidence intervals (CI) [0.96, 2.28], p = 0.08 and OR = 1.45, 95% CI [0.94, 2.22], p = 0.09, respectively), including those due to NF-GNB (OR = 1.90, 95% CI [0.93, 3.33], p = 0.05 and OR = 1.76, 95% CI [0.93, 3.33], p = 0.08, respectively). No difference was found for 28 days-mortality (OR = 1.24, 95% CI [0.92, 1.67], p = 0.16), mechanical ventilation duration, number of extra-pulmonary infections and length of ICU stay. However, short-course therapy significantly increased the number of antibiotic-free days.
UNASSIGNED: Our meta-analysis showed that short-course antibiotic therapy did not result in increased number of recurence and relapses of VAP, suggesting that short-course should be preferred to reduce the exposure to antibiotics.
UNASSIGNED: None.