Effect of C-Reactive Protein-Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia: A Randomized Clinical Trial

摘要

Key PointsQuestionDoes antibiotic treatment with C-reactive protein (CRP)-guided duration or fixed 7-day duration, compared with fixed 14-day duration, provide noninferior clinical failure rates in patients with uncomplicated gram-negative bacteremia? FindingsIn this randomized clinical trial that included 504 adults with uncomplicated gram-negative bacteremia, 30-day clinical failure occurred in 2.4% of patients assigned to receive CRP-guided antibiotic treatment duration, 6.6% assigned to 7-day treatment, and 5.5% assigned to 14-day treatment. The differences between CRP-guided treatment and 7-day treatment compared with 14-day treatment met the noninferiority criterion of 10%, but adherence to the CRP strategy or planned follow-up did not occur in 23% of patients. MeaningCRP-guided treatment and 7-day treatment were noninferior to 14-day treatment in patients with uncomplicated gram-negative bacteremia, but interpretation is limited by the large noninferiority margin compared with the low observed event rate and lower adherence in the CRP-guided group.