Short-Course Therapy for Uncomplicated VRE Bacteremia: This is Us Trying (to Shorten Therapy)

Abstract

Background: The optimal treatment duration for uncomplicated vancomycin-resistant Enterococcus (VRE) bacteremia is unclear. Shorter courses may reduce adverse events (AEs) and hospital length of stay (LOS) without compromising clinical outcomes. Objective: To evaluate clinical outcomes associated with short-course (≤6 days) vs long-course (>6 days) therapy in hospitalized adults with uncomplicated VRE bacteremia. Methods: We conducted a single-center, retrospective study of adults with uncomplicated VRE bacteremia between 2014 and 2024. Patients who received ≤6 days of definitive antibiotic therapy were compared with those who received >6 days. The primary outcome was 30-day bacteremia recurrence. Secondary outcomes included infection-related readmission, 30- and 90-day all-cause mortality, post-bacteremia hospital LOS, and antibiotic-related AEs. Descriptive statistics, chi-square, and Fisher’s exact tests were used. Results: Of the 48 patients included, 10 received short-course therapy and 38 received long-course, with median treatment durations of 5 days (interquartile range [IQR] 4-6) and 12 days (IQR 6-18), respectively. No recurrences were observed in either group. Infection-related readmissions occurred only in the long-course group (7.9%, n = 3; P = 0.49). Thirty-day mortality rates were 30% (short-course) vs 21.1% (long-course; P = 0.41), and the 90-day mortality rates were 30% vs 29%, respectively. Median post-bacteremia hospital LOS was shorter in the short-course group (10.5 vs 13 days; P = 0.68). The AEs were similar between groups. Conclusion: In this small exploratory cohort, short-course therapy (≤6 days) for uncomplicated VRE bacteremia was not associated with higher recurrence, readmission, or mortality than longer courses. These hypothesis-generating results support further studies on abbreviated treatments in carefully selected patients.