Seven versus Fourteen Days of Antibiotics for Gram-Negative Bacteremia from a Urinary Tract Source: a Systematic Review and Meta-analysis
Abstract
Introduction: The optimal duration of antibiotic therapy for Gram-negative bacteremia sourced from urinary tract infections (UTI) remains uncertain. We performed a systematic review and meta-analysis comparing short-course (approximately 7 days) versus prolonged-course (approximately 14 days) antibiotic therapy in this population.
Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov through 26 April 26 2025. Studies were included if they compared 7-day versus 14-day antibiotic therapy in Gram-negative bacteremia with ≥ 65% UTI source or performed a dedicated UTI subgroup analysis. Outcomes assessed included 30- and 90-day mortality and recurrence rates. Recurrence was defined as a repeat episode of Gram-negative bacteremia confirmed by a positive blood culture after completion of therapy, rather than recurrence of urinary tract infection alone. Risk ratios (RR) were pooled using a random-effects model. Noninferiority was assessed using a prespecified margin of RR 1.25, and superiority was assessed with a threshold of RR < 1.00.
Results: In total, six studies (three randomized trials, three observational cohorts) encompassing 4448 patients were included. There were no significant differences between short- and prolonged-course therapy for 30-day mortality (RR 0.97, 95% confident interval (CI) 0.64-1.47; p = 0.90), 30-day recurrence (RR 1.38, 95% CI 0.80-2.37; p = 0.24), 90-day mortality (RR 0.90, 95% CI 0.77-1.06; p = 0.20), or 90-day recurrence (RR…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,448 participants or records.
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