Grant: CIHR Clinician Scientist - Phase 2

Bloodstream infections are a common and serious problem, affecting 15% of critically ill patients, increasing their length of hospital stay by 3 weeks, adding $40,000 in excess hospital costs, and tripling the risk of death. At the same time, antibiotic overuse is also a common and serious problem, in that 30-50% of antibiotic use is unnecessary or inappropriate, and results in avoidable drug side effects such as kidney failure, Clostridium difficile colitis, increased costs, and spiraling antibiotic resistance rates. The greatest contributor to antibiotic overuse is excessive durations of treatment. Extensive research has demonstrated that shorter duration antibiotic therapy (± 1 week) is as effective as longer duration therapy for a variety of infectious diseases, but this question has never been directly studied in the setting of bloodstream infection. Our systematic review of the medical literature and national survey of Canadian infectious diseases and critical care physicians support the need for a trial comparing shorter (7 days) versus longer (14 days) antibiotic therapy for bloodstream infections. Prior to performing this trial, through the Canadian Critical Care Trials Group, we propose this Canada-wide prospective observational study in order to: 1) confirm that there is variability in current treatment practices; 2) identify which patients and pathogens are appropriate to include in a future trial; and 3) confirm that the benefits of antibiotics are achieved within the first week. By defining the optimal duration of treatment for bloodstream infections, our research program will help maximize the clinical cure of individual patients, while minimizing their risk of drug side effects, C.difficile, and antibiotic resistance. Since this intervention would require no new technology, and would reduce (rather than increase) health care costs, it would offer immediate benefits to patients and the healthcare system.