The New England Journal of MedicineAntibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections

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A landmark multicenter noninferiority trial involving 3,608 hospitalized patients across 74 hospitals in seven countries demonstrated that 7-day antibiotic treatment was noninferior to 14-day treatment for bloodstream infections. The study, which included both ICU and non-ICU patients, showed comparable mortality rates and clinical outcomes between the two treatment durations, potentially changing the standard approach to managing bacteremia.

Key Points:

• Primary outcome showed 14.5% mortality at 90 days in the 7-day group versus 16.1% in the 14-day group (difference: -1.6 percentage points; 95.7% CI, -4.0 to 0.8)
• Most common infection sources: urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin/soft tissue (5.2%)
• Study excluded patients with severe immunosuppression, prosthetic heart valves, endovascular grafts, and Staphylococcus aureus infections
• Noninferiority maintained across subgroups, including ICU patients (55% of cohort) and various pathogen types
• Secondary outcomes, including hospital mortality, ICU mortality, and bacteremia relapse rates, showed no significant differences between groups

“Adopting a 7-day treatment strategy requires no new expensive medications or technologies, could lead to large savings in drug-acquisition costs, and has the potential to generate downstream benefits in selection of antimicrobial resistance at an individual and population level.”

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