Short Course Compared to Standard Antibiotic Courses for Treatment of Uncomplicated Gram-negative Bacteremia in Pediatric HCT Recipients
Hayley E Scheerer, Sandra Castejon Ramirez, Jose A Ferrolino, Li Tang, Ronald H Dallas, Kim J Allison, Ali Suliman, Heather L Glasgow, Randall T Hayden, Gabriela Maron, Diego R HijanoAbstract
Background
Gram-negative bloodstream infections (GN-BSI) are a significant cause of morbidity and mortality worldwide. Pediatric hematopoietic cell transplant (HCT) recipients are at an increased risk of GN-BSI. Studies in healthy individuals and immunocompromised adults have shown comparable clinical outcomes, including treatment failure and mortality, with reduced treatment durations (7-10 days compared to 14 days). However, evidence is lacking in immunocompromised pediatric populations. We describe our experience with shorter courses of antibiotic therapy for GN-BSI at St. Jude Children’s Research Hospital.
Methods
GN-BSI infections in pediatric HCT recipients (age <18 years) from 30 days pre-transplant, to 100 days post autologous HCT and 365 days post allogeneic HCT were identified via retrospective chart review between 2010 and 2023. Complicated BSI, polymicrobial infections involving gram-positive bacterial or fungal organisms, patients who received <7 days appropriate therapy or died prior to completing antibiotics were excluded. Complicated BSI was defined as infection requiring >10 days antibiotic therapy (ie. endocarditis, septic thrombophlebitis, osteomyelitis). Clinical outcomes were compared between patients treated with shorter course (≤10 days) compared to longer antibiotic courses (>10 days). Fisher’s exact test was used to compare microbiological relapse (identification of the same organism from previous BSI on blood culture) and all-cause mortality at 30 and 90 days after completion of antibiotics. Statistical analysis was performed using R Studio.
Result
A total of 190 episodes of GN-BSI met inclusion criteria (Table 1). Of these, 78 (41.0%) received a short course and 112 (58.9%) received a longer course of antibiotics. The median duration of therapy for the short-course group was 10 days (IQR, 9-10) and 14 days (IQR, 12-16) for the longer course group. There were no significant differences in microbiological relapse (p=1), or all-cause mortality at 30-days (p=0.51) or 90-days (p=0.084) between short and longer course groups. Although not statistically significant, 90-day all-cause mortality was higher in the longer course group than in the short course group (13.4% vs 5.1%).
Conclusions
Our study demonstrates that shorter antibiotic courses for GN-BSI in pediatric HCT recipients did not significantly increase treatment failure or mortality rates when compared to longer regimens. These findings have important implications for antimicrobial stewardship, suggesting that reducing treatment duration for uncomplicated GN-BSI in this patient population may be a safe and effective strategy to minimize antibiotic exposure without compromising clinical outcomes. However, further prospective, randomized controlled trials are warranted to validate these results and establish optimal treatment durations for GN-BSI in pediatric HCT recipients.