P-24. Seven Versus Fourteen Days of Antibiotics for Gram-Negative Bacteremia from a Urinary Tract Source:A Systematic Review and Meta-Analysis

Abstract Background The optimal duration of antibiotic therapy for gram-negative bacteremia sourced from urinary tract infections (UTI) remains uncertain. We performed a systematic review and meta-analysis comparing short-course (approximately 7 days) versus prolonged-course (approximately 14 days) antibiotic therapy in this population.Figure 1:Forest plot of outcomesTable 1:Study design Methods We systematically searched PubMed, Embase, and ClinicalTrials.gov through April 26, 2025. Studies were included if they compared 7-day versus 14-day antibiotic therapy in gram-negative bacteremia with ≥65% UTI source or performed a dedicated UTI subgroup analysis. Outcomes assessed included 30- and 90-day mortality and recurrence rates. Risk ratios (RR) were pooled using a random-effects model. Noninferiority was assessed using a prespecified margin of RR 1.25, and superiority was assessed with a threshold of RR < 1.00. Results Six studies (three randomized trials, three observational cohorts) encompassing 4,448 patients were included. There were no significant differences between short- and prolonged-course therapy for 30-day mortality (RR 0.97, 95% CI 0.64–1.47; p=0.90), 30-day recurrence (RR 1.38, 95% CI 0.80–2.37; p=0.24), 90-day mortality (RR 0.90, 95% CI 0.77–1.06; p=0.20), or 90-day recurrence (RR 0.68, 95% CI 0.45–1.01; p=0.06). Conclusion Our findings suggest that a 7-day course may be sufficient for most patients with UTI-sourced gram-negative bacteremia. Disclosures All Authors: No reported disclosures