| Summary: | Background: Ideal therapy duration for <i>Pseudomonas aeruginosa</i> or <i>Acinetobacter baumannii-calcoaceticus complex</i> (ABC) bloodstream infections (BSI) is not defined, especially in the context of carbapenem resistance. In this study, we compared short- (≤7 days) and long-term (>7 days) antimicrobial therapy duration for these infections. Methods: We performed a retrospective cohort study in two tertiary-care hospitals in Porto Alegre, Brazil, from 2013 to 2019. Eligible patients aged ≥18 years were included and excluded for the following criteria: polymicrobial infections, treatment with non-susceptible antibiotics, complicated infections, or early mortality (<8 days of active antimicrobial therapy). The 30-day mortality risk was evaluated using a Cox regression model. Results: We included 237 BSI episodes, 51.5% caused by <i>ABC</i> and 48.5% by <i>Pseudomonas aeruginosa</i>. Short-term therapy was not associated with 30-day mortality, adjusted hazard ratio 1.01, 95% confidence interval 0.47–2.20, <i>p</i> = 0.98, when adjusted for Pitt score (<i>p</i> = 0.02), Charlson Comorbidity Index score (<i>p</i> < 0.01), and carbapenem resistance (<i>p</i> < 0.01). Among patients who survived, short-term therapy was associated with shorter hospital stay (<i>p</i> < 0.01). Results were maintained in the subgroups of BSI caused by carbapenem-resistant bacteria (<i>p</i> = 0.76), <i>ABC</i> (<i>p</i> = 0.61), and <i>Pseudomonas aeruginosa</i> (<i>p</i> = 0.39). Conclusions: Long-term therapies for non-complicated <i>Pseudomonas aeruginosa</i> and ABC BSI were not superior to short-term therapy for 30-day mortality.
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