Short course of antimicrobial treatment for uncomplicated enterococcal bacteremia

Duration of treatment for uncomplicated enterococcal bacteremia is unknown. This study aims to evaluate the clinical outcomes of patients treated with short courses (4-10 days) compared to those receiving longer regimens (11-18 days).

This retrospective study was conducted at the Lausanne University Hospital, Switzerland (January 2015-June 2024) and included adult patients with uncomplicated enterococcal bacteremia. Primary outcome was a composite of mortality, recurrence of bacteremia by the same enterococcal species and development of bone and joint infection within 120 days.

During the study period, 331 episodes of uncomplicated enterococcal bacteremia were included. The median duration of antimicrobial treatment was 12 days (interquartile range: 8-15); 138 (42%) and 193 (58%) episodes received a short (4-10 days) and long (11-18 days) duration of antimicrobial treatment, respectively. The primary endpoint was observed in 77 (23%) episodes; 120-day mortality was 21% (69 episodes), recurrence of bacteremia was 4% (12 episodes), and bone and joint infection was 0.6% (2 episodes). No difference in primary endpoint was observed between episodes receiving short and long courses of antimicrobial treatment (23% versus 23%; P = 1.000). The Cox multivariable regression model found that malignancy (aHR 2.00, 95% CI 1.24-3.22), immunosuppression (1.78, 1.09-2.90), cirrhosis (2.53, 1.42-4.51), and sepsis or septic shock (2.48, 1.52-4.03) were associated with primary endpoint; a short course of antimicrobial treatment was not associated with primary endpoint (1.03, 0.65-1.62).

Among uncomplicated enterococcal bacteremia giving a short duration of antimicrobial treatment is reasonable.