Despite the severity and frequency of bloodstream infections (BSI) the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the efficacy and safety of step down oral antibiotics for the treatment of Streptococcusspp BSI.
This was a retrospective cohort study of adult, hospitalized patients with Streptococcusspp BSI between 6/2015-6/2017. Patients were excluded if received <48h of antibiotic therapy or therapy was started >48h from first positive culture. Patients were grouped by receipt of step down oral antibiotic therapy (PO group) vs full course IV therapy (IV group) and compared for demographics, clinical course, and outcomes. The primary outcome was 30d mortality and hospital length of stay (LOS). The secondary outcomes included 30d recurrence of BSI and adverse events (AEs).
195 patients met inclusion criteria; median age was 51yo, 68% were male, 57% were Hispanic, and 71% had community-onset BSI. 64 (33%) were treated with step down oral therapy. The most common source of bacteremia was pneumonia (21%); 8% had endocarditis. Comorbidities were similar between the groups, with diabetes being most common (IV 22% vs PO 19%, p=0.29). Severity of illness measured by need for ICU admission, initial lactate level, and SOFA score, were similar between two groups. S. viridanswas the most frequent pathogen isolated (IV 28% vs PO 27%, p=.87). Ceftriaxone (39%) for the IV group and levofloxacin (30%) for the PO group were the most common definitive therapy prescribed. PO group received 4d of IV therapy prior to transition to orals. The IV group had significantly higher mortality rate (11% vs 2%, p=0.02) and longer LOS (median 9d [IQR 5-18] vs 5d [4-7.75], p=<.01) compared to the PO group. 30d recurrence (IV 2% vs PO 5%, p=.40) and AEs (IV 2% vs PO 3%, p=.60) were similar between the two groups.
In Streptococcusspp BSI, step down oral antibiotic therapy was associated with a significantly shorter LOS compared with IV only therapy without compromise of clinical outcomes. Larger prospective trials evaluating step down oral therapy are warranted to confirm our results.
J. Chen, None
M. Gandawidjaja, None
E. Minejima, None