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Published on: May 31, 2010
IV Antibiotic Durations for Nontyphoidal Salmonella Bacteremia
Lauren M Hess1,2,3, Bethany Burdick3, Charles G Minard4
1Department of Pediatrics, lhess@bcm.edu.
Objectives:
The objective was to determine if shorter intravenous (IV) antibiotic (<7 days) for nontyphoidal Salmonella bacteremia (NTS-B) is noninferior to longer (≥7 days) in terms of 30-day emergency department (ER) or rehospitalization in healthy children.
Methods:
A retrospective observational study of otherwise healthy children admitted to a children's hospital in the United States from 2006 to 2017 with NTS-B was conducted.
Results:
Of 231 patients reviewed, 51 patients had NTS-B. Median IV duration for all patients was 5 days (range 2-17 days). The short-duration group (SDG) (<7 days; N = 32) had a median of 4 days (range 2-6 days) of IV antibiotics versus a median of 9 days (range 7-17 days) in the long-duration group (LDG) (≥7 days; N = 19). The hospital length of stay in the SDG was 3.5 days versus 7 days in the LDG (P < .001). The SDG was significantly noninferior to the LDG in terms of ER visits or hospital readmissions within 30 days (absolute risk difference 5.3%; 95% confidence interval -16% to -5%), with only 1 child in the LDG returning to the ER.
Conclusions:
IV antibiotic durations for NTS-B in otherwise healthy children were variable within our study group. Shorter courses (<7 days) of IV antibiotics were noninferior to longer courses in healthy children and reduced hospital stay. ER visits and readmissions were rare, and there was no association between IV treatment duration and risk of relapse. Prospective studies are needed to study the safety of shorter courses, but given the absence of evidence favoring longer courses, shorter courses can be considered.
Insights
Shorter intravenous (IV) antibiotic courses (<7 days) for nontyphoidal Salmonella bacteremia (NTS-B) in children are as effective as longer courses (≥7 days). Shorter IV antibiotic durations reduce hospital stays without increasing 30-day emergency room visits or rehospitalizations.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
Background:
- Nontyphoidal Salmonella bacteremia (NTS-B) is a significant pediatric infection.
- Current treatment guidelines often recommend prolonged intravenous (IV) antibiotic courses for NTS-B.
- Optimizing antibiotic duration is crucial for effective treatment and antimicrobial stewardship.
Purpose of the Study:
- To evaluate the noninferiority of shorter IV antibiotic durations (<7 days) compared to longer durations (≥7 days) for NTS-B in healthy children.
- To assess the impact of IV antibiotic duration on 30-day emergency department (ER) visits or rehospitalizations.
Main Methods:
- Retrospective observational study of healthy children with NTS-B admitted between 2006 and 2017.
- Comparison of outcomes between a short-duration group (SDG, <7 days IV antibiotics) and a long-duration group (LDG, ≥7 days IV antibiotics).
- Analysis of 30-day ER visits and rehospitalization rates as primary outcomes.
Main Results:
- The SDG (median 4 days IV) was noninferior to the LDG (median 9 days IV) regarding 30-day ER visits or rehospitalizations.
- Children receiving shorter IV antibiotic courses had a significantly shorter hospital length of stay (3.5 days vs. 7 days).
- ER visits and readmissions were infrequent, with no statistically significant association with IV treatment duration.
Conclusions:
- Shorter IV antibiotic courses (<7 days) are a safe and effective alternative for treating NTS-B in otherwise healthy children.
- Shorter durations are associated with reduced hospital length of stay without compromising patient safety.
- Further prospective studies are warranted, but current evidence supports considering shorter IV antibiotic courses for NTS-B.
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