Grant: Project Grant

Bloodstream infections (BSI) are a common and serious problem, affecting 15% of seriously ill patients, increasing length of stay in hospital and doubling mortality. Antibiotic overuse is also a serious problem: 30-50% of antibiotic use is unnecessary or inappropriate and results in avoidable side effects, C. difficile infection, costs, and spiralling antibiotic resistance. The greatest contributor to overuse is excessive treatment durations. Shorter antibiotic treatment (<= 7 days) is as effective as longer treatment for infectious diseases such as bladder infections and pneumonia, but this question has not been studied for hospitalized patients with BSI. Our team's systematic review of the medical literature, national survey, multicentre retrospective study and pilot trial, all supported the need for and feasibility of a randomized controlled trial comparing shorter (7 days) versus longer (14 days) antibiotic treatment for BSI. With a CIHR 2016 Project Grant, we launched the main BALANCE trial to determine whether 7 days of treatment is associated with non-inferior survival rates as compared to 14 days. We have leveraged CIHR's investment with Australian and New Zealand grants and successfully enrolled 1477 patients of the target 3626. We are due to finish on-time and on budget by our original proposal which was endorsed by CIHR as the appropriate mechanism to answer the questions posed. We have demonstrated the ability to engage the international community across 6 countries and 56 centres, have recruited at our target rate, and propose that this "finishing grant" is an excellent return on the original investment. By defining the duration of treatment for BSI, BALANCE will help maximize the clinical cure of individual patients, while minimizing their risk of drug side effects, C. difficile, and antibiotic resistance.