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The optimal duration of therapy for primary BSI and BSI secondary to major organ system infections has been poorly defined.
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A reduction in the length of antibiotic courses is, therefore, a potentially viable strategy to minimize the consequences of antibiotic overuse in critical care, including antibiotic resistance, adverse effects, Clostridium difficile colitis, and costs. Up to half of the antibiotic use in hospital wards and critical care units is unnecessary or inappropriate, and excessive durations of treatment are the greatest contributor to inappropriate use. In contrast, it may be more feasible to reduce antibiotic use at the back end of treatment courses. Mortality rates may be higher if delayed or ineffective initial antimicrobial therapy is prescribed, and so it is difficult to reduce broad-spectrum antibiotic use in the initial empiric phase of treatment in this vulnerable patient population. These infections are a major contributor to patient morbidity and are associated with a doubling or even tripling of mortality. A recent global point prevalence survey of infections in 1,265 intensive care units (ICUs) documented bloodstream infection (BSI) among 15% of patients, and this rate may be increasing over time because of increased use of immunosuppressive drugs, invasive procedures, and older patients who have concomitant medical conditions and who are admitted to intensive care.