What is the evidence for the duration of antibiotic therapy in Gram-negative bacteraemia caused by urinary tract infection? A systematic review of the literature

The frequency of secondary bacteraemia is variable depending on the site of infection but is often associated with significant morbidity and mortality. The most common source of Gram-negative bacteraemia is urinary tract infection (UTI). Current guidelines on the treatment of UTI provide no clear guidance on whether the presence of bacteraemia influences the duration or choice of therapy. Here we systematically review the current evidence base for the duration of treatment of Gram-negative bacteraemia secondary to UTI. The available evidence is sparse and of variable quality to draw any firm conclusions. However, in the absence of urgently required high-quality studies, current limited evidence appears to indicate that short courses of antibiotics are as effective at obtaining clinical and bacteriological cure as longer courses.