Short Versus Long Duration of Therapy for Streptococcus Pneumoniae Bloodstream Infections

Study Overview
=================
Brief Summary
-----------------
Streptococcus pneumoniae is a gram-positive (GP) bacteria responsible for common infections such as community-acquired pneumonia (CAP), as well as complicated infections such as bacteremia, infective endocarditis and meningitis. S. pneumoniae bacteremia ranks among the top 10 most common pathogens associated with bloodstream infections and correlates with high morbidity and mortality worldwide.

Detailed Description
-----------------
The Infectious Diseases Society of America (IDSA) guidelines for CAP management advocate for short courses of antibiotics for CAP treatment. However, it does not address duration of therapy for common CAP pathogens such as S. pneumoniae when associated with blood stream infections (BSI). 3 Currently, GP bacteremia duration of therapy typically ranges from 7 to 14 days based on IDSA guideline recommendations for Staphylococcus aureus bacteremia with no further definitive consensus.4 Additionally, lack of data and randomized clinical trials on the efficacy and safety of short compared to long treatment duration have led to variability in practice. Most randomized clinical trials as well as retrospective studies on treatment duration, have been conducted mainly in gram-negative BSI

Official Title
-----------------
Short Versus Long Duration of Therapy for Streptococcus Pneumoniae Bloodstream

Conditions
-----------------
Streptococcus Pneumoniae

Intervention / Treatment
-----------------
* Drug: pneumoniae bacteremia therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: • ≥18 years of age S. pneumoniae isolated from ≥1 blood cultures Active IV antibiotic therapy within 48 hours of the first positive blood culture(7,8) Clinical stability by day 10 of therapy Exclusion Criteria: • Treatment duration <5 days or >16 days Death before completion of therapy (<10 days vs. ≥ 10 days ) Polymicrobial BSI Invasive infection caused by S. pneumoniae (endocarditis, meningitis, and lung abscess)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: pneumoniae bacteremia therapy|To evaluate the effectiveness of short 10 days versus long (≥10 days) duration of therapy associated with S. pneumoniae bacteremia.|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Infection related-hospitalization | hospital readmission with streptococcal pneumonia, bacteremia, endocarditis, meningitis, and lung abscess within 30 days of antibiotic completion | 30 days | 
| Recurrence | Reinfection with streptococcal pneumonia, within 30 days of antibiotic completion | 30 days | 
| All-cause mortality | Death within 30 days of antibiotic completion | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU Length of stay(LOS) | length of ICU stay | 30 days | 
| Hospital LOS | length of hospital stay | 30 days | 
| Occurrence of C. difficile infection | Number of times of C.difficile infections | 30 days | 
| Total antibiotic treatment duration | Number of times of antibiotic treatment duration | 30 days | 
| Central venous catheter placement | placement of venous catheter | 30 days |