e1ca8ecec7bebb67ece77134b6368100 322312.pdf c51f71b6621e4a1af9c28723a9bf1928657706c1 322312.pdf 1b6c4971a400fa590c95ba409b55c04b70d1d19cc0546e37da5a3783c8495b91 322312.pdf Title: An Update on Recent Clinical Trial Data in Bloodstream Infection Subject: Bloodstream infections (BSIs) remain a significant source of morbidity and mortality globally, exacerbated by an ageing population and rising antimicrobial resistance (AMR). This review offers an updated evaluation of randomized clinical trials (RCTs) in BSI management from 2018 onwards, focusing on the evolving landscape of diagnostics and treatment. New rapid diagnostic technologies and shorter antimicrobial courses have transformed clinical practice, reducing the time to appropriate therapy and hospital stays. Several RCTs demonstrated that rapid phenotypic and genotypic tests shorten the time to optimal therapy, especially when paired with antimicrobial stewardship. Ongoing trials are investigating novel antimicrobial regimens and the safety of early oral switch strategies, particularly for Gram-positive and Gram-negative BSIs. Recent RCTs on Staphylococcus aureus BSI (SAB) and multidrug-resistant Gram-negative bacteria highlight advances in treatment but emphasize the need for further study into the efficacy of combination therapies and the utility of rapid diagnostics in different healthcare settings. The review also explores challenges in trail design, with adaptive and pragmatic appropriates improving the efficacy of clinical trials. Finally, this paper identifies gaps in the research, including the need for further investigation into oral step-down therapy, optimal durations, and the role of rapid diagnostics in resource-limited settings. Keywords: bacteraemia; bloodstream infection; clinical trial Author: Adam G. Stewart, Peter Simos, Pirathaban Sivabalan, Laura Escolà-Vergé, Katherine Garnham and Burcu Isler Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri Nov 1 15:35:51 2024 CET ModDate: Fri Nov 1 15:37:20 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 307109 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- AXNGGN+URWPalladioL-Bold Type 1 Custom yes yes no 10 0 IFLHFE+URWPalladioL-Roma Type 1 Custom yes yes no 15 0 PUAYAG+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 NMEOAF+VnURWPalladioL Type 1 Custom yes yes no 23 0 MWJZGO+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 CNXSVA+CMSY10 Type 1 Builtin yes yes no 64 0 LWLIVD+EURM10 Type 1 Builtin yes yes no 92 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-12-20 04:17:04 CET RepresentationInformation: 322312.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-12-19 09:59:21 CET Size: 307109 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 362 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Laboratory Investigations for Bloodstream Infection Destination: section.2 Item: Title: Treatment of Gram-Positive Bacteria Destination: section.3 Item: Title: Treatment of Gram-Negative Bacteria Destination: section.4 Item: Title: Candidemia Trials Destination: section.5 Item: Title: Comparing Duration and Route of Administration of Antimicrobials for Bloodstream Infection Destination: section.6 Item: Title: New Clinical Trial Design and Knowledge Gaps Requiring Prioritization for Future Bloodstream Infection Trials Destination: section.7 Item: Title: Conclusions Destination: section.8 Item: Title: References Destination: section.9 Info: Title: An Update on Recent Clinical Trial Data in Bloodstream Infection Author: Adam G. Stewart, Peter Simos, Pirathaban Sivabalan, Laura Escolà-Vergé, Katherine Garnham and Burcu Isler Subject: Bloodstream infections (BSIs) remain a significant source of morbidity and mortality globally, exacerbated by an ageing population and rising antimicrobial resistance (AMR). This review offers an updated evaluation of randomized clinical trials (RCTs) in BSI management from 2018 onwards, focusing on the evolving landscape of diagnostics and treatment. New rapid diagnostic technologies and shorter antimicrobial courses have transformed clinical practice, reducing the time to appropriate therapy and hospital stays. Several RCTs demonstrated that rapid phenotypic and genotypic tests shorten the time to optimal therapy, especially when paired with antimicrobial stewardship. Ongoing trials are investigating novel antimicrobial regimens and the safety of early oral switch strategies, particularly for Gram-positive and Gram-negative BSIs. Recent RCTs on Staphylococcus aureus BSI (SAB) and multidrug-resistant Gram-negative bacteria highlight advances in treatment but emphasize the need for further study into the efficacy of combination therapies and the utility of rapid diagnostics in different healthcare settings. The review also explores challenges in trail design, with adaptive and pragmatic appropriates improving the efficacy of clinical trials. Finally, this paper identifies gaps in the research, including the need for further investigation into oral step-down therapy, optimal durations, and the role of rapid diagnostics in resource-limited settings. 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