From the Research
Patients with uncomplicated gram-negative bacteremia can be discharged home after 7 days of antibiotic therapy, as this duration has been shown to be noninferior to 14 days in terms of outcomes, including morbidity, mortality, and quality of life 1. The decision to discharge a patient home after bacteremia depends on several factors, including the causative organism, source of infection, patient's comorbidities, and overall clinical response.
- Patients can be discharged once they have been clinically stable for at least 24-48 hours, showing normal vital signs, have negative follow-up blood cultures, and demonstrate good response to antibiotics.
- The specific duration of hospital stay depends on the complexity of the case, with uncomplicated bacteremia typically requiring shorter stays and more complicated cases, such as MRSA bacteremia or endocarditis, requiring longer hospital stays.
- Before discharge, it's essential to ensure the patient can reliably take oral medications, has appropriate follow-up arranged, understands warning signs requiring medical attention, and has a clear plan for completing the full antibiotic course. Key considerations in determining the discharge timeframe include:
- The patient's ability to manage their condition at home, including taking medications and monitoring for signs of complications.
- The availability of follow-up care and support, including access to healthcare providers and laboratory testing.
- The patient's overall health status and risk factors for complications, such as underlying medical conditions or immunocompromised state. According to a study published in 2019, a 7-day course of antibiotic therapy was noninferior to a 14-day course in patients with uncomplicated gram-negative bacteremia, with no significant differences in outcomes, including morbidity, mortality, and quality of life 1. Other studies have also investigated the optimal duration of antibiotic therapy for bacteremia, including a study on Staphylococcus aureus bacteremia, which found that persistent bacteremia was associated with increased risk of poor outcomes, including metastatic complications, length of stay, and 30-day mortality 2. However, the study by 1 provides the most recent and highest-quality evidence on this topic, and its findings support the use of a 7-day course of antibiotic therapy for uncomplicated gram-negative bacteremia.