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Introduction <p>The optimal duration of antibiotic therapy for Gram-negative bacteremia sourced from urinary tract infections (UTI) remains uncertain. We performed a systematic review and meta-analysis comparing short-course (approximately 7&#xa0;days) versus prolonged-course (approximately 14&#xa0;days) antibiotic therapy in this population.</p> Methods <p>We systematically searched PubMed, Embase, and ClinicalTrials.gov through 26 April 26 2025. Studies were included if they compared 7-day versus 14-day antibiotic therapy in Gram-negative bacteremia with ≥ 65% UTI source or performed a dedicated UTI subgroup analysis. Outcomes assessed included 30- and 90-day mortality and recurrence rates. Recurrence was defined as a repeat episode of Gram-negative bacteremia confirmed by a positive blood culture after completion of therapy, rather than recurrence of urinary tract infection alone. Risk ratios (RR) were pooled using a random-effects model. Noninferiority was assessed using a prespecified margin of RR 1.25, and superiority was assessed with a threshold of RR &lt; 1.00.</p> Results <p>In total, six studies (three randomized trials, three observational cohorts) encompassing 4448 patients were included. There were no significant differences between short- and prolonged-course therapy for 30-day mortality (RR 0.97, 95% confident interval (CI) 0.64–1.47; <i>p</i> = 0.90), 30-day recurrence (RR 1.38, 95% CI 0.80–2.37; <i>p</i> = 0.24), 90-day mortality (RR 0.90, 95% CI 0.77–1.06; <i>p</i> = 0.20), or 90-day recurrence (RR 0.68, 95% CI 0.45–1.01; <i>p</i> = 0.06).</p> Conclusions <p>Our findings suggest that a 7-day course may be sufficient for most patients with UTI-sourced Gram-negative bacteremia.</p>

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Seven versus Fourteen Days of Antibiotics for Gram-Negative Bacteremia from a Urinary Tract Source: a Systematic Review and Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月11日

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  • Graciela Luna,
  • Andrea Rodriguez,
  • Chidozie Igbonagwam,
  • Zein Barakat,
  • Daniela Carralero-Somoza,
  • Zoya Khan,
  • Garret Snyder,
  • Mark Soliman,
  • Imad Dibo,
  • Michael Sabina

摘要

Introduction

The optimal duration of antibiotic therapy for Gram-negative bacteremia sourced from urinary tract infections (UTI) remains uncertain. We performed a systematic review and meta-analysis comparing short-course (approximately 7 days) versus prolonged-course (approximately 14 days) antibiotic therapy in this population.

Methods

We systematically searched PubMed, Embase, and ClinicalTrials.gov through 26 April 26 2025. Studies were included if they compared 7-day versus 14-day antibiotic therapy in Gram-negative bacteremia with ≥ 65% UTI source or performed a dedicated UTI subgroup analysis. Outcomes assessed included 30- and 90-day mortality and recurrence rates. Recurrence was defined as a repeat episode of Gram-negative bacteremia confirmed by a positive blood culture after completion of therapy, rather than recurrence of urinary tract infection alone. Risk ratios (RR) were pooled using a random-effects model. Noninferiority was assessed using a prespecified margin of RR 1.25, and superiority was assessed with a threshold of RR < 1.00.

Results

In total, six studies (three randomized trials, three observational cohorts) encompassing 4448 patients were included. There were no significant differences between short- and prolonged-course therapy for 30-day mortality (RR 0.97, 95% confident interval (CI) 0.64–1.47; p = 0.90), 30-day recurrence (RR 1.38, 95% CI 0.80–2.37; p = 0.24), 90-day mortality (RR 0.90, 95% CI 0.77–1.06; p = 0.20), or 90-day recurrence (RR 0.68, 95% CI 0.45–1.01; p = 0.06).

Conclusions

Our findings suggest that a 7-day course may be sufficient for most patients with UTI-sourced Gram-negative bacteremia.