THE DURATION OF THERAPY RECOMMENDED FOR BACTEREMIC ILLNESS VARIES WIDELY AMONGST CLINICIANS

Abstract Introduction The optimum duration of antimicrobial therapy would eradicate infection whilst minimizing potential adverse drug effects to the patient. Methods Australian and New Zealand ID and ICU specialists were surveyed regarding their recommended duration of antibiotic treatment for five common syndromes leading BSI. Results 239 clinicians responded to the survey (15.5% ICU and 84.5% ID). Overall the most common reported durations were 7 (33.7%), 10 (25.8%) and 14 (26%) days, with 46% of responses recommending 7d days or less. Most respondents (>75% for each characteristic) would not modify duration based on host characteristics such as patient age or comorbidities. ID physicians recommended longer durations than critical care physicians for all five syndromes (ID 10d IQR 7-14 range 1-28, ICU 7d, 5-10, 2-21). Across all respondents the median duration for each syndrome was: central vascular catheter-related BSI 7 (IQR= 7-10) days; bacteraemic pneumonia 7 (7-10) days; bacteraemic urinary tract infection 10 (7-14) days; bacteraemic intra-abdominal infection 7 (7-12) days; and bacteraemic skin and soft-tissue infection, 10 (7-14) days. Conclusion Marked variation exists amongst clinician's recommended duration of antibiotic treatment for BSI. A proportion of clinicians recommend therapy of 7 days or less at present(33.3-59.7% across the scenarios) . Patient characteristics are not strongly considered in the decision of durations of therapy. This survey was undertaken as preparatory work for initiation of the BALANCE (Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness) study, an ongoing randomized trial comparing 7 to 14 days of therapy for BSI, providing an evidence base to inform best clinical treatment for this patient population.