Optimizing the Management of Uncomplicated Gram-Negative Bloodstream Infections: Consensus Guidance Using a Modified Delphi Process.

Abstract

BACKGROUND:

Guidance on the recommended durations of antibiotic therapy, the use of oral antibiotic therapy, and the need for repeat blood cultures remain incomplete for gram-negative bloodstream infections. We convened a panel of infectious diseases specialists to develop a consensus definition of uncomplicated gram-negative bloodstream infections to assist clinicians with management decisions.

METHODS:

Panelists, who were all blinded to the identity of other members of the panel, used a modified Delphi technique to develop a list of statements describing preferred management approaches for uncomplicated gram-negative bloodstream infections. Panelists provided level of agreement and feedback on consensus statements generated and refined them from the first round of open-ended questions through 3 subsequent rounds.

RESULTS:

Thirteen infectious diseases specialists (7 physicians and 6 pharmacists) from across the United States participated in the consensus process. A definition of uncomplicated gram-negative bloodstream infection was developed. Considerations cited by panelists in determining if a bloodstream infection was uncomplicated included host immune status, response to therapy, organism identified, source of the bacteremia, and source control measures. For patients meeting this definition, panelists largely agreed that a duration of therapy of ~7 days, transitioning to oral antibiotic therapy, and forgoing repeat blood cultures, was reasonable.

CONCLUSIONS:

In the absence of professional guidelines for the management of uncomplicated gram-negative bloodstream infections, the consensus statements developed by a panel of infectious diseases specialists can provide guidance to practitioners for a common clinical scenario.

• Authors: Emily L Heil, Jacqueline T Bork, Lilian M Abbo, Tamar F Barlam, Sara E Cosgrove, Angelina Davis, David R Ha, Timothy C Jenkins, Keith S Kaye, James S Lewis 2nd, Jessica K Ortwine, Jason M Pogue, Emily S Spivak, Michael P Stevens, Liza Vaezi, Pranita D Tamma
• Journal: Open forum infectious diseases (Open Forum Infect Dis) Vol. 8 Issue 10 Pg. ofab434 (Oct 2021) ISSN: 2328-8957 [Print] United States
• PMID: 34738022 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.