Recurrence of Group B Streptococcal infection similar in shortened and prolonged therapy
The rates of Group B Streptococcal (GBS) bacteremia recurrence in infants with an initial course of late-onset infection who received shortened and prolonged IV antibiotic therapy were 1.8% and 2.3%, respectively. There was no significant difference in the adjusted absolute difference between these 2 rates.
Evidence Rating Level: 2 (Good)
Study Rundown: GBS is the most common bacterial infection in infants, with no significant change in rates of late onset GBS infection (occurring at 7 to 90 days of age). Current guidelines published by the Committee on Infectious Diseases recommend prolonged IV antibiotic therapy (10 days) for uncomplicated GBS bacteremia. The purpose of this study was to compare rates of failure in subjects with late onset GBS who received prolonged (10 days) or shortened (≤8 days) antibiotic therapy. The primary outcome, recurrent GBS infection (defined as hospital revisit with a discharge diagnosis of GBS bacteremia, meningitis, or osteomyelitis within the first year of life) occurred at low rates in both the prolonged and shortened IV therapy groups, with no significant differences between the rates. Treatment failure (defined as recurrence of GBS disease 14 days from hospital discharge) similarly occurred at low rates in both groups, without significant differences between rates. The study was limited by reliance on medical coding, although validating testing was performed, and lack of data on possible use of outpatient antibiotics following admission. These data suggest that shortened IV therapy may be a reasonable alternative to prolonged IV therapy in GBS infection, preventing prolonged hospital stays and iatrogenic infections.
In-Depth [retrospective cohort]: Subjects were identified through the Pediatric Health Information System Database (PHIS), a comparative pediatric database consisting of 49 children's hospitals in the United States. Inclusion criteria included age ≤4 months and discharge from a PHIS center between January 2000 and September 2015 with an ICD-9 discharge code of GBS disease or bacteremia. Subjects were excluded for age <7 days, ICD-9 codes for an invasive bacterial or viral infection, a concomitant non-GBS bacterial infection, prematurity <29 weeks' gestational age (GA), birth weight (BW) <1500g or a severe hospital course requiring intensive care. Out of 1369 infants ≤4 months of age with GBS bacteremia, 775 were included in the final analysis; of these, 612 (79%) received prolonged IV therapy and 163 (21%) received shortened IV therapy. The sensitivity for ICD-9 coding in detecting GBS bacteremia (confirmed with culture) was 72% and the PPV was 96%. The most common antibiotics prescribed were ampicillin and third-generation cephalosporins (37%), followed by cephalosporin monotherapy (28%) and a third-generation cephalosporin and vancomycin (7%). There were 17 (2.2%) patients who developed the primary outcome of GBS recurrence: 3 (1.8%) in the shortened IV therapy group and 14 (2.3%) in the prolonged IV therapy group (adjusted absolute difference = -0.2%, 95% CI = -3.0%-2.5%).Treatment failure in the shortened and prolonged IV therapy groups occurred in 1 (0.5%) and 6 (1%) subjects, respectively (adjusted absolute difference = -0.3%, 95% CI = -1.8%-1.1%).
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