Optimizing the management of uncomplicated gram-negative bloodstream infections: Consensus guidance using a modified Delphi process

Antibiotic Stewardship Implementation Collaborative

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numberofab434
JournalOpen Forum Infectious Diseases
Volume8
Issue number10
DOIs
StatePublished - Oct 1 2021

Keywords

  • Bacteremia
  • Blood cultures
  • Duration of therapy
  • Oral step-down therapy

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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