Short Versus Long Antibiotic Duration in Streptococcus pneumoniae Bacteremia

Abstract

Background: Streptococcus pneumoniae is a common pathogen associated with bloodstream infections, respiratory infections, peritonitis, infective endocarditis, and meningitis. Literature assessing duration of antibiotic therapy for a S pneumoniae bacteremia secondary to common infection is scarce, leading to variability in practice. Therefore, this study evaluated the effectiveness of short (5-10 days) versus long (11-16 days) antibiotic durations for S pneumoniae bacteremia.

Methods: This retrospective, single-center cohort study assessed hospitalized patients with S pneumoniae-positive blood cultures, who received active antibiotics within 48 hours of first positive blood culture collection and achieved clinical stability by day 10 of the first positive blood culture collection. Exclusion criteria included treatment duration <5 or >16 days, death before completion of 10 days of therapy, polymicrobial bloodstream infection, and invasive infection. Rates of clinical failure (composite of 30-day hospital readmission, bacteremia recurrence, and mortality) were compared between the groups.

Results: A total of 162 patients were included, with 51 patients in the short- and 111 patients in the long-duration group. Pneumonia was the suspected source of bacteremia in 90.1% of patients. Rates of clinical failure were not significantly different between the 2 groups. Patients received a median antibiotic course of 7 days in the short group compared to 14 days in the long group; however, there was no significant difference observed in the median hospital length of stay, median intensive care unit length of stay, or rate of Clostridioides difficile infection.

Conclusions: Shorter antibiotic courses may be appropriate in patients with S pneumoniae bacteremia secondary to community-acquired pneumonia.

Keywords: Streptococcus pneumoniae; antimicrobial stewardship; bloodstream infection; duration of treatment; pneumonia.