Evidence map›Paper›PMID 29452598›Full record

Trial reportTrials2018

7 versus 14 days of antibiotic treatment for critically ill patients with bloodstream infection: a pilot randomized clinical trial.

Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Pierre Aslanian, Sean M Bagshaw, Alex Carignan, Emmanuel Charbonney, Bryan Coburn, Deborah J Cook, Michael E Detsky and 15 more

Registry-linked trialOpen access · goldAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Trials, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02261506 (Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness), which is not on this map. Cited by 23 papers.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed
5.5field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02261506 nacompletednot on this map

Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness: A Pilot RCT

TypeinterventionalSponsorSunnybrook Health Sciences CentreRan2014 to 2017Enrolled115ConditionsBacteremiaArms7 days of adequate antibiotic treatment durations, 14 days of adequate antibiotic treatment durations
3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 57 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Review
  4. Article
  5. Article
  6. Article
  7. Association between in-hospital antibiotic use and long-term outcomes in critically ill patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025
    Article
  8. Article
  9. Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024
    Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Recommendations for antibiotic selection for severe nosocomial infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2021
    Article
  16. Popularization of "10".Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2021
    Article
  17. Duration of antibiotic therapy for common infections.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2021
    Article
  18. Review
  19. Bloodstream Infection Etiology among Children and Adults.International journal of microbiology · 2021
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors at 11 institutions in 1 country.

Nick DanemanDivision of Infectious Diseases and Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto and Adjunct Scientist, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. nick.daneman@sunnybrook.ca.
Asgar H RishuDepartment of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Ruxandra PintoDepartment of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Pierre AslanianService de Soins Intensifs et Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Sean M BagshawDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Alex CarignanDepartment of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada.
Emmanuel CharbonneyDepartment of Critical Care Medicine, Hôpital du Sacré-Coeur de Montreal and Hôpital de Trois-Rivières, University of Montreal, Montreal, QC, Canada.
Bryan CoburnDivision of Infectious Diseases, University of Toronto, Toronto, ON, Canada.
Deborah J CookDivision of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Michael E DetskyDivision of Critical Care, Department of Medicine, Sinai Health System, Toronto, ON, Canada.
Peter DodekDivision of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of BC, Vancouver, BC, Canada.
Richard HallDepartments of Critical Care Medicine and Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
Anand KumarSection of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
Francois LamontagneCentre de Recherche du CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
Francois LauzierCentre de Recherche du CHU de Québec-Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Division de Soins Intensifs, Québec, QC, Canada.
John C MarshallDepartments of Surgery and Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Claudio M MartinDepartment of Medicine, University of Western Ontario, London, ON, Canada.
Lauralyn McIntyreDivision of Critical Care, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
John MuscedereDepartment of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Steven ReynoldsDepartment of Biophysiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
Wendy SliglDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Henry T StelfoxDepartment of Critical Care Medicine, Institute of Public Health, University of Calgary, Calgary, AB, Canada.
M Elizabeth WilcoxDivision of Critical Care, Department of Medicine, Toronto Western Hospital, Toronto, ON, Canada.
Robert A FowlerDepartments of Medicine and Critical Care Medicine, Sunnybrook Health Sciences Center, Adjunct Scientist, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Canadian Critical Care Trials Group
Sunnybrook Health Science Centre · CAUniversité de Sherbrooke · CAUniversity of Alberta · CADalhousie University · CASinai Health System · CAUniversity of Toronto · CAWestern University · CAQueen's University · CASimon Fraser University · CASt. Michael's Hospital · CAUniversity of Calgary · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundShorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial.

methodsWe conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs). Antibiotic selection, dosing and route were at the discretion of the treating team; patients were randomized 1:1 to intervention arms consisting of two fixed durations of treatment - 7 versus 14 days. We recruited adults with a positive blood culture yielding pathogenic bacteria identified while in ICU. We excluded patients with severe immunosuppression, foci of infection with an established requirement for prolonged treatment, single cultures with potential contaminants, or cultures yielding Staphylococcus aureus or fungi. The primary feasibility outcomes were recruitment rate and adherence to treatment duration protocol. Secondary outcomes included 90-day, ICU and hospital mortality, relapse of bacteremia, lengths of stay, mechanical ventilation and vasopressor duration, antibiotic-free days, Clostridium difficile, antibiotic adverse events, and secondary infection with antimicrobial-resistant organisms.

resultsWe successfully achieved our target sample size (n = 115) and average recruitment rate of 1 (interquartile range (IQR) 0.3-1.5) patient/ICU/month. Adherence to treatment duration was achieved in 89/115 (77%) patients. Adherence differed by underlying source of infection: 26/31 (84%) lung; 18/29 (62%) intra-abdominal; 20/26 (77%) urinary tract; 8/9 (89%) vascular-catheter; 4/4 (100%) skin/soft tissue; 2/4 (50%) other; and 11/12 (92%) unknown sources. Patients experienced a median (IQR) 14 (8-17) antibiotic-free days (of the 28 days after blood culture collection). Antimicrobial-related adverse events included hepatitis in 1 (1%) patient, Clostridium difficile infection in 4 (4%), and secondary infection with highly resistant microorganisms in 10 (9%). Ascertainment was complete for all study outcomes in ICU, in hospital and at 90 days.

conclusionIt is feasible to conduct a RCT to determine whether 7 versus 14 days of antibiotic treatment is associated with comparable 90-day survival.

trial registrationClinicalTrials.gov , identifier: NCT02261506 . Registered on 26 September 2014.

Indexed as

AgedAnti-Bacterial AgentsBacteremiaCanadaCommunity-Acquired InfectionsCritical IllnessCross InfectionDrug Administration ScheduleFeasibility StudiesFemaleHumansIntensive Care UnitsMaleMiddle AgedPilot ProjectsTime FactorsAnti-Bacterial AgentsBacteremiaBloodstream infectionCritical careDuration of treatmentIntensive care

Identifiers

PMID29452598
PMCPMC5816399
OpenAlexW2788732937

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.