Michelle Hamani, Ruxandra Pinto, Todd C. Lee, Derek MacFadden, Emily G. McDonald, Wendy Sligl, Robert Fowler, Nick Daneman, Nick Daneman, Nick Daneman, Nick Daneman, Asgar Rishu, Ruxandra Pinto, Benjamin A. Rogers, Yahya Shehabi, Rachael Parke, Deborah J. Cook, Yaseen Arabi, John Muscedere, Steven Reynolds, Richard Hall, Dhiraj Bhatia Dwivedi, Colin McArthur, Shay McGuinness, Dafna Yahav, Anna Geagea, Pavani Das, Phillip Shin, Michael Detsky, Andrew Morris, Michael Fralick, Jeff Powis, Christopher Kandel, Wendy Sligl, Sean M. Bagshaw, Nishma Singhal, Emilie Belley-Cote, Richard Whitlock, Kosar Khwaja, Susan Morpeth, Alex Kazemi, Tony Williams, Derek MacFadden, Lauralyn McIntyre, Jennifer Tsang, Francois Lamontagne, Alex Carignan, John Marshall, Jan O. Friedrich, Rob Cirone, Mark Downing, Christopher Graham, Joshua S. Davis, Erick Duan, John Neary, Gerald Evans, Basem Alraddadi, Sameera Aljohani, Claudio Martin, Sameer Elsayed, Ian Ball, François Lauzier, Alexis F. Turgeon, Henry Thomas Stelfox, John Conly, Todd C. Lee, Emily G. McDonald, Richard Sullivan, Jennifer Grant, Ilya Kagan, Paul Young, Cassie Lawrence, Kevin O'Callaghan, Matthew Eustace, Keat Choong, Pierre Aslanian, Ulrike Buehner, Tom Havey, Alexandra Binnie, Josef Prazak, Brenda Reeve, Edward Litton, Sylvain A. Lother, Anand Kumar, Ryan Zarychanski, Tomer Hoffman, David L. Paterson, Peter Daley, Robert J. Commons, Emmanuel Charbonney, Jean-Francois Naud, Sally Roberts, Ravindranath Tiruvoipati, Sachin Gupta, Gordon Wood, Omar Shum, Spiros Miyakis, Peter Dodek, Clement Kwok, Linda R. Taggart
OBJECTIVES: The Bacteremia Antibiotic Length Actually Needed For Clinical Effectiveness (BALANCE) randomized clinical trial demonstrated 7 days to be noninferior to 14 days of antibiotics for bacteraemia. Uncertainty remains as to whether shortened treatment durations are sufficient for immune compromised patients. METHODS: /L) and transplantation but allowed enrolment of other forms of immune compromise; this post-hoc subgroup analysis focused on these immune compromised patients. The primary outcome was 90-day mortality. The primary analysis was in the intention-to-treat population with sensitivity analyses among the modified intention-to-treat population limited to those who survived ≥7 days. RESULTS: Among BALANCE patients, 1037 (28.7%) were considered immune compromised; 530 were randomized to receive 7 days of antibiotics and 507 to receive 14 days. The most common types of immune compromise included solid malignancies (75.4%), leukaemia/lymphoma (9.7%), chemotherapy (15.4%), corticosteroid use (4.7%), and HIV/AIDS (2.3%). Despite being formally excluded, a small number of neutropenic patients were enrolled (2.5%). Patients received a median (interquartile range) of 8 (7-11 days) versus 14 (14-15 days) days of antibiotics in the two arms. All-cause 90-day mortality in the intention-to-treat population was 106/528 (20.1%) in the 7 days arm and 120/507 (23.7%) in the 14 days arm (risk difference, -3.6%; 95% CI, -8.6-1.4; p = 0.16). In the modified intention-to-treat analysis, 90-day mortality was 104/526 (19.8%) in the 7 days arm and 117/504 (23.2%) in the 14 days arm (risk difference, -3.4%; 95% CI -8.5-1.6, p = 0.18). CONCLUSIONS: This post-hoc analysis of the immune compromised subgroup of the BALANCE randomized controlled trial suggests that the shorter treatment duration was sufficient for bacteraemia in these patients.