Abstract
Introduction
Hospital-acquired bloodstream infections (HA-BSIs) are severe and require antibiotic therapy. In non-complicated BSIs, shortened therapy reduces side effects without compromising efficacy. The impact of shortened antibiotic therapy in HA-BSI critically ill patients without indication of prolonged therapy requires further evaluation.
Methods
Using the international prospective EUROBACT-2 cohort, we compared shortened (7–10 days) versus long (14–21 days) treatment durations in ICU patients eligible for shortened therapy. Patients without antibiotic therapy within 3 days after HA-BSI occurrence or requiring prolonged therapy (due to infection source, microorganism, or clinical deterioration) were excluded. Treatment failure, defined as death, persistent infection, or subsequent infectious complications by Day 28, was assessed using an inverse-probability of treatment weighted (IPTW) logistic regression.
Results
Among 2600 patients, 550 were eligible for shortened treatment, 213 received short, and 337 received long treatment. The most common infection source was respiratory (33%), most common microorganisms were Enterobacterales (39%). Patients with long treatment were more frequently infected with Staphylococcus aureus (11% vs. 5.6%, p = 0.025) or difficult-to-treat microorganisms (23% vs. 7%, p < 0.001), and received more commonly combination therapy (46% vs. 30%, p < 0.001). Short treatment was associated with reduced 28-day treatment failure (OR 0.64, 95% CI 0.44–0.93, p = 0.019), mainly due to reduction in subsequent infectious complications (OR 0.58, 95% CI 0.37–0.91, p = 0.018). Mortality (OR 0.92 [95% CI 0.59, 1.43], p = 0.7) and persistent infection rates (OR 0.47 [95% CI 0.17, 1.14], p = 0.12) were similar.
Conclusions
In selected ICU patients with HA-BSI, shortened antibiotic treatment might be considered. Eurobact2 was a prospective international cohort study, registered in ClinicalTrials.org (NCT03937245).
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Availability of data and material
The datasets used and/or analyzed during the current study are available from the OUTCOMEREA organization on reasonable request.
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Acknowledgements
The EUROBACT-2 study was endorsed by the European Society of Intensive Care Medicine (ESICM), the infection section of the ESCIM and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP), with scientific input of the OUTCOMEREA network. The Eurobact 2 study group is listed in the electronic supplementary material 2.
Funding
Eurobact2 original study was funded by the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP), the Norva Dahlia foundation and the Redcliffe Hospital Private Practice Trust Fund.
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LG, NB, SR and JFT designed and conducted the study. LG and SR performed the statistical analyses. LG wrote the first draft of the manuscript. All authors performed critical review of the manuscript. NB and JFT supervised the writing process.
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LG has nothing to disclose, NB has nothing to disclose, AT has nothing to disclose, SR has nothing to disclose, MA has nothing to disclose, FS has nothing to disclose, KA has nothing to disclose JJW has nothing to disclose, HB has nothing to disclose, FB reported consulting fees from Shionogi, lecture fees from MSD and Advanz Pharma, conference invitations from Pfizer, and research grants from MSD, JFT reported advisory boards participation for Merck, Gilead, Beckton-Dickinson, Pfizer, Menarini, Advanz, Paratek, research grants from Merck and Pfizer.
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Initial ethical approval as a low-risk research project with waiver of individual consent was granted by the Human Research Ethics Committee of the Royal Brisbane & Women’s Hospital, Queensland, Australia (LNR/2019/ QRBW/48376). Each study site then obtained ethical and governance approvals according to national and/or local regulations.
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The members of the Eurobact2 study group are listed in electronic supplementary material 2.
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Gajdos, L., Buetti, N., Tabah, A. et al. Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database. Intensive Care Med 51, 518–528 (2025). https://doi.org/10.1007/s00134-025-07857-6
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DOI: https://doi.org/10.1007/s00134-025-07857-6