Short duration antimicrobial therapy for non-staphylococcal Gram-positive bacteremia (SHORT-STOP)
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc gme pharmacy
Disciplines
Medical Education
Abstract
Recent clinical trials have demonstrated non-inferiority of shorter antibiotic courses for many infections, including gram-negative bacteremia. Longer courses were associated with numerically fewer deaths in the gram-positive subgroup of the BALANCE trial; however, only ~15% of the cohort had streptococcal or enterococcal bacteremia. Conversely, other retrospective studies have demonstrated comparable mortality in uncomplicated streptococcal or enterococcal bacteremia but many of these studies targeted narrow populations, limited pathogens, or were susceptible to confounding variables. The purpose of this study is to determine if patients with uncomplicated non-staphylococcal gram-positive bacteremia can be safely managed with short course antimicrobial therapy. This is a retrospective, multicenter cohort study examining adult (age >= 18 years) patients admitted for an uncomplicated non-staphylococcal gram-positive bloodstream infection blood stream infection from 9/1/2024 to 9/1/2025 at 8 hospitals within a multistate health system. Patients were excluded if they were diagnosed with an active infection requiring prolonged duration of therapy (eg. endocarditis, osteomyelitis), presence of prosthetic material or endovascular grafts, if blood cultures suggest contamination, or if diagnosed with polymicrobial bacteremia. The primary outcome was 30-day all-cause mortality. Secondary outcomes include recurrent bacteremia and Clostridioides difficile infections; all outcomes were assessed at 30 and 90 days. Patient sex, age, ethnicity, comorbidities, organism identified, length of hospital stay, source of infection, and formal infectious disease consult will be collected as well. Patient characteristics were summarized with descriptive statistics. Differences between short and long course therapy were compared using chisquare, Fisher’s exact, Wilcoxon rank-sum, and Student’s t-tests as appropriate. Multivariable logistic regression will be used to model the relationship between treatment duration and outcome, with results reported as odds ratios and associated 95% confidence intervals. Variable selection was determined a priori based on expert input. Approximately 693 patients were examined; preliminary data was collected through electronic extraction and manual chart review of patients’ electronic health records. Approximately 61.6% of patients were male and the most common organisms isolated were Streptococcus pyogenes, Streptococcus pneumoniae, and Enterococcus faecalis. Full results and conclusions will be shared when the project is completed. The study was determined to be exempt from IRB review. Learning objective: Identify the optimal antimicrobial duration in those diagnosed with uncomplicated, non-staphylococcal, Gram-positive bacteremia. Category: Infectious disease
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
