Ming Liu, Ya Gao, Li Zheng, Zhifan Li, Liang Yao, Jianguo Xu, Qingyong Zheng, Ping Zeng, Jinhui Tian
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引用次数: 0
Abstract
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.
背景：血流感染抗生素治疗的最佳持续时间仍不确定。本研究旨在比较较短时间和较长时间抗生素治疗对血液感染免疫功能正常患者的疗效和安全性。方法：我们检索Medline、Embase和Cochrane中央对照试验注册库（Central Register of Controlled Trials，无语言限制），检索数据库建立至2024年11月25日期间发表的随机对照试验（rct），比较较短时间抗生素治疗与较长时间抗生素治疗对血流感染患者的影响，治疗时间最少差异为3天。我们采用随机效应荟萃分析来总结证据。我们使用95%置信区间（ci）的均值差（MD）作为连续结果。对于二分类结果，我们使用95% ci的比值比（ORs）或风险比（rr）。我们使用分级推荐评估、发展和评价（GRADE）框架来评估证据的确定性。本研究已在Open Science Framework （https://osf.io/egs8q）注册。结果：2006年至2025年间发表的11项随机对照试验，共涉及5505名受试者，证明符合条件。死亡率差异可能很小或没有差异(RR 0.91, 95% CI 0.79-1.05；中度确定性)，治疗失败(RR 1.08, 95% CI 0.69-1.68；中度确定性)和复发率(RR 1.15, 95% CI 0.82-1.63；中等确定性)在短期和长期抗生素之间。与较长疗程的抗生素相比，较短疗程的抗生素不会增加再入院率(RR 0.91, 95% CI 0.75-1.1；高确定性)，但减少住院时间(MD -3.04, 95% CI -3.9至-2.18；高确定性)。由于确定性证据非常低，我们不确定与长效抗生素相比，短期抗生素是否能减少任何不良事件（RR 1.0, 95% CI 0.76-1.32）和严重不良事件（RR 0.67, 95% CI 0.39-1.14）。解释：较短和较长疗程的抗生素对血流感染的疗效相似，疗程较短可减少住院时间。在不同年龄组和细菌类型中观察到一致的效果，但由于亚组数据有限，需要谨慎解释。资金:没有。
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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