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Published on: August 30, 2018
Outcomes of Short Antibiotic Courses for Gram-Negative Bloodstream Infections in Solid Organ Transplant Recipients-A
Muath Alotaibi1,2, Abdulellah Almohaya3,4,5, Roni Bitterman2
1Department of Medicine, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia.
Background:
Gram-negative bloodstream infections (GN-BSIs) contribute significantly to morbidity and mortality. Optimizing antibiotic duration is critical, particularly in immunocompromised populations, but data for solid organ transplant (SOT) recipients remain limited.
Objective:
To examine the effectiveness of short versus long antibiotic courses for GN-BSIs in SOT recipients.
Methods:
This systematic review followed PRISMA guidelines (PROSPERO CRD42024620638). We searched four databases through June 2025 for randomized controlled trials (RCTs) and observational studies reporting outcomes in SOT recipients. Risk of bias was assessed, and random-effects meta-analyses were conducted. Primary outcome was 90-day mortality; secondary outcomes included clinical failure.
Results:
Seven studies (2 RCTs, 5 cohorts) involving 249 SOT patients were analyzed. In RCTs, 90-day mortality (RD: -0.07; 95% CI: -0.18 to 0.05; p = 0.25) and clinical failure (RR: 0.62; 95% CI: 0.18-2.15; p = 0.45) were lower in the short-course group. In cohort studies, 90-day mortality (RR: 0.36; 95% CI: 0.06-2.08; p = 0.25) was also lower, but clinical failure (RR: 1.89; 95% CI: 0.81-4.43; p = 0.14) was higher in the short-course group. None of the differences were statistically significant. Certainty of evidence was moderate in RCTs, and very low in the cohort studies.
Conclusion:
Our review underscores the importance of including SOT recipients in trials comparing short versus long antibiotic therapy for GN-BSIs. Although no statistically significant differences were observed between treatment durations, the limited sample size precludes definitive conclusions and highlights the need for larger, high-quality studies.
Insights
Short antibiotic courses for gram-negative bloodstream infections (GN-BSIs) in solid organ transplant (SOT) recipients showed no significant difference in mortality or clinical failure. More research is needed due to limited sample sizes.
Area of Science:
- Infectious Diseases
- Transplant Medicine
- Pharmacology
Background:
- Gram-negative bloodstream infections (GN-BSIs) are a significant cause of mortality.
- Optimizing antibiotic duration is crucial, especially for immunocompromised patients like solid organ transplant (SOT) recipients.
- Limited data exist on optimal antibiotic durations for GN-BSIs in SOT recipients.
Purpose of the Study:
- To evaluate the effectiveness of short versus long antibiotic courses for treating GN-BSIs in SOT recipients.
- To synthesize evidence from existing randomized controlled trials (RCTs) and observational studies.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched four databases for RCTs and observational studies up to June 2025.
- Conducted random-effects meta-analyses assessing 90-day mortality and clinical failure, with risk of bias assessment.
Main Results:
- Seven studies (2 RCTs, 5 cohorts) with 249 SOT patients were analyzed.
- In RCTs, short-course antibiotics showed trends towards lower mortality and clinical failure, but not statistically significant.
- Cohort studies indicated lower mortality with short courses, but higher clinical failure; evidence certainty was moderate to very low.
Conclusions:
- No statistically significant differences in outcomes were found between short and long antibiotic courses for GN-BSIs in SOT recipients.
- The limited sample size of current studies prevents definitive conclusions.
- Larger, high-quality trials are necessary to guide antibiotic duration in this vulnerable population.
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