Shortened Antibiotic Course in Late-Onset GBS Bacteremia

Abstract

Research Article| February 01 2019 Shortened Antibiotic Course in Late-Onset GBS Bacteremia AAP Grand Rounds (2019) 41 (2): 21. https://doi.org/10.1542/gr.41-2-21 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Shortened Antibiotic Course in Late-Onset GBS Bacteremia. AAP Grand Rounds February 2019; 41 (2): 21. https://doi.org/10.1542/gr.41-2-21 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bacteremia, antibiotic therapy, intravenous Source: Coon ER, Srivastava R, Stoddard G, et al. Shortened IV antibiotic course for uncomplicated, late-onset group B streptococcal bacteremia. Pediatrics. 2018; 142(5): e20180345; doi: https://doi.org/10.1542/peds.2018-0345Google Scholar Investigators from the University of Utah and Cincinnati Children’s Hospital Medical Center conducted a retrospective cohort study to determine the effect of an IV antibiotic course for uncomplicated, late-onset group B Streptococcus (GBS) bacteremia that was shorter than the recommended 10 days. The cohort was identified using the Pediatric Health Information System (PHIS) database, which provides demographic, billing, and administrative data for patients cared for at 49 US children’s hospitals. PHIS patients were eligible for inclusion in study analyses if they were 7 days to 4 months of age and were discharged from a PHIS hospital between 2000 and 2015 with an ICD-9 discharge diagnosis code for GBS disease and bacteremia. Patient demographics and medical history (eg, history of prematurity, other infections) were abstracted from the PHIS database. The primary exposure of interest was receipt of a shortened course of IV antibiotics, defined as ≤8 days. Patients with a procedure code or hospital charge for a peripherally inserted central catheter were not classified as having received a shortened course regardless of the measured duration of antibiotics while hospitalized (as they were assumed to have completed a longer antibiotic course). The primary outcome was recurrence of GBS disease, defined as a hospital revisit for GBS disease and bacteremia, meningitis, or osteomyelitis in a patient’s first year of life (using ICD-9 codes). Investigators tested the association between exposure and outcome by using propensity-adjusted logistic regression. There were 775 infants included in analysis. Of these, 21% (n=163) received a shortened course of IV antibiotics. A higher proportion of infants who received (vs did not receive) a shortened course were older and had a concomitant UTI. Overall, recurrence of GBS disease occurred in 2.2% (n=17). There was no difference in recurrence of GBS among patients who did and did not receive a shortened course of IV antibiotics (1.8% vs 2.3%, respectively; adjusted absolute difference, −0.2%; 95% CI, −3.0%–2.5%). The investigators conclude that GBS recurrence rates are low with a shortened course of IV antibiotics for uncomplicated, late-onset GBS bacteremia. Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. There exists a paradox for pediatricians caring for very young patients with documented GBS bacteremia. The AAP Red Book recommendation is treatment with 10 days of IV antibiotics,1 but one cannot find primary evidence to support this expert consensus. With a lack of data to oppose it, this recommendation has become the national standard of care. Although the current study begins to develop an evidence base for shortening the course in this clinical setting, it is even more interesting that >20% of patients in this study were treated with ≤8 days of IV antibiotics. According... You do not currently have access to this content.