Antibiotic stewardship in hematological patients with Escherichia coli and Klebsiella pneumoniae bloodstream infections: evaluating short-course and carbapenem-sparing strategies

Ann Clin Microbiol Antimicrob. 2025 May 29;24(1):34. doi: 10.1186/s12941-025-00801-y.

Abstract

Background: To address the overuse of antibiotics, this study examined the clinical characteristics and outcomes associated with antibiotic duration and carbapenem-sparing regimens in hematological patients with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bloodstream infections (BSI).

Methods: We conducted a retrospective analysis of hematological patients with E. coli or K. pneumoniae BSI from 2017 to 2023. Propensity score matching (PSM) controlled for confounding variables, and data were analyzed using multivariate regression models.

Results: A total of 1,862 patients were included (E. coli: n = 932; K. pneumoniae: n = 930). Among 1,105 patients in the antibiotic duration cohort, 48.96% (n = 541) received short-course therapy (median: 8 days, IQR: 7-9), while others received prolonged-course therapy (median: 14 days, IQR: 12-17). No significant differences in 30-day mortality or 90-day recurrence rates were observed between the two groups, either before or after PSM. In the antibiotic regimen cohort (n = 1,606), we assessed the effectiveness of carbapenem-containing versus carbapenem-sparing regimens, as well as monotherapy versus combination therapy. Among 1,488 patients with non-carbapenem-resistant Enterobacteriaceae (non-CRE) infections, 567 had infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. In this subgroup, 30-day mortality rates also showed no significant differences between carbapenem-containing and carbapenem-sparing regimens, both before and after PSM.

Conclusion: In conclusion, short-course antibiotic therapy is as effective as prolonged therapy for treating E. coli and K. pneumoniae BSI in hematological patients. Similarly, carbapenem-sparing regimens are non-inferior to carbapenem-based regimens. These findings highlight the potential for optimizing antibiotic use, but further validation through randomized controlled trials is warranted.

Keywords: Antibiotic stewardship; Bloodstream infections; Carbapenem-sparing regimens; Hematological; Short-course therapy.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents* / therapeutic use
  • Antimicrobial Stewardship*
  • Bacteremia* / drug therapy
  • Bacteremia* / microbiology
  • Carbapenems* / therapeutic use
  • Escherichia coli Infections* / drug therapy
  • Escherichia coli Infections* / microbiology
  • Escherichia coli* / drug effects
  • Female
  • Humans
  • Klebsiella Infections* / drug therapy
  • Klebsiella Infections* / microbiology
  • Klebsiella pneumoniae* / drug effects
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Carbapenems