Shorter Versus Longer Course of Antibiotics for Bloodstream Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: A Multicenter Study in Saudi Arabia

Background: There is no consensus regarding the optimal duration of antibiotic therapy for carbapenemase-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs). We sought to compare survival in hospitalized patients with CRKP-BSIs who received shorter versus longer courses of antibiotics.

Methods: We conducted a propensity-score matched (PSM) retrospective multicenter study of adults who were diagnosed with CRKP-BSIs and received antibiotics for ≥ 72 hours. Our outcomes were 30-day mortality, 90-day mortality, and clinical cure. We compared patients treated with short (≤10 days) versus long (>10 days) antibiotic courses.

Results: Our PSM analysis included 97 patients. Of which, 32 patients received short-course antibiotics and 65 patients received long course antibiotics. We identified a significantly higher odds for clinical cure among those who received a course antibiotics (OR 1.25; 95% CI 1.02 – 1.53; p = 0.030). No difference was observed in 30-day and 90-day mortality between short and long antibiotic groups. Among patients with septic shock, receiving a prolonged course was associated with a significantly lower odds of 30-day mortality (OR 0.75; 95% CI 0.62 – 0.90; p = 0.002) and 90-day mortality (OR 0.75, 95% CI 0.65 – 0.86; p <0.001), and higher odds for clinical cure (OR 1.4, 95% CI 1.2 – 1.77; p <0.001)

Conclusion: For patients with CRKP-BSIs, 10 days of therapy may be sufficient; however, a longer duration of treatment may be warranted for septic shock patients.