Uncomplicated Late-Onset Group B Streptococcal Bacteremia: Can We Do Less Than 10 Days IV?

Abstract

* Abbreviations: GBS — : group B streptococcal IV — : intravenous LO-GBS — : late-onset group B streptococcal Late-onset group B streptococcal (LO-GBS) bacteremia remains a common serious infection in early infancy. It can be associated with meningitis, osteomyelitis, or other focal sites of infection but often occurs as uncomplicated bloodstream infection. Current authoritative sources recommend 10 days of intravenous (IV) antimicrobial therapy for uncomplicated LO-GBS bacteremia.1,2 In this issue of Pediatrics , Coon et al3 report an observational, comparative effectiveness study that revealed no difference in group B streptococcus (GBS) recurrence risk in young infants treated with shortened IV courses (≤8 days of IV therapy) versus prolonged courses (>8 days) for uncomplicated bacteremia. We know that 10 days IV works well for this infection and is effective and safe, right? So, why wrestle with questions about duration of therapy? With a growing literature on potential impacts of antimicrobial therapy on the infant microbiome that may matter later in life, risks of antimicrobial resistance, risks associated with hospitalization in general, financial and social burdens of hospitalizations on families, and well-described IV catheter-associated risks during home IV therapy, addressing this question is reasonable. A place to start is, “How did we come to recommendations of 10 days of IV therapy for this entity?” In his 1990 review of recommended durations of antimicrobial therapy for bacterial meningitis in children, Radetsky4 stated, “…the standards for … Address correspondence to Charles R. Woods, MD, MS, Department of Pediatrics, University of Tennessee College of Medicine–Chattanooga, Children's Hospital at Erlanger, 910 Blackford St, Chattanooga, TN 37403. E-mail: charles.woods{at}erlanger.org