Seven versus Fourteen Days of Antibiotics for Gram-Negative Bacteremia from a Urinary Tract Source: a Systematic...

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.

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.

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).

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