SHORTER courses of antibiotics have been associated with increased risk of reinfection and death when used to treat infants in the neonatal intensive care unit (NICU) for Escherichia coli bacteraemia, a new study has shown. Before this, research has consistently suggested that shorter courses of antibiotics may be as effective as longer courses for certain infections, a concept often referred to as ‘shorter is better’. The approach has been particularly relevant in paediatric care, where infections are a leading cause of mortality in infants. This study, however, highlights that the optimal duration of antibiotic therapy for E. coli bacteraemia in infants remains unclear.
Researchers examined data from over 400 NICUs and over 1.6 million patients in the USA between 1997–2020. The study focused on infants with first instance E. coli who received antibiotics within 2 days of an index culture, and who were not evaluated for meningitis due to concerns of clinical instability. Treatment outcomes were compared, including in-hospital mortality and recurrence of infection, based on three lengths of antibiotic course: <14 days (44% of infants), 14–21 days (30% of infants), and >21 days (26% of infants).
The study revealed a significant association between the duration of antibiotic therapy and patient outcomes. Infants who received <14 days of antibiotics experienced higher odds of infection recurrence or death. Notably, infants who underwent a cerebrospinal fluid (CSF) evaluation with negative culture and no pleocytosis did not experience worse outcomes with shorter antibiotic durations. However, for infants who did not undergo CSF evaluation, shorter durations of antibiotic therapy were linked to higher mortality rates.
These findings underscore that, while shorter courses of antibiotics have shown efficacy in various infections, including paediatric cases, such an approach may not be suitable for E. coli bacteraemia in NICU patients. However, as explained by lead researcher Ashley Stark, Duke University School of Medicine, Durham, North Carolina, USA, more research is needed to find the optimum treatment approach.
“Although we showed that there was no increase in mortality in infants with E. coli bacteraemia who did undergo a CSF evaluation, we don’t know the exact number of days for antibiotic therapy that is appropriate since we grouped our antibiotic durations into three categories,” Stark said. “Is it 10 days? Fourteen days? Future studies would also need to clarify this important question.”
Reference
Stark A et al. Duration of therapy for Escherichia coli bacteremia without CSF evaluation in the NICU: is shorter better? PAS Meeting, 2-6 May, 2024.
