1050. Oral Antibiotics for the Treatment of Gram-negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • ID Week 2018 GN PO BSI.pdf (776.6 kB)
  • Background: There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center.

    Methods: Retrospective observational cohort of adult patients (age ≥ 18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 – May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use.

    Results:

    During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3 – 11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs 47.7%, p < 0.0001) and were less likely to have an ID consult (57.5% vs 71.1%, p= 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0 – 4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (versus low) bioavailable antibiotics in patients with ID consult compared to those without (59% vs 41%, p = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared to patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, p = 0.006), however ID-related readmission was rare (0.9% vs 1%, p = 0.91).

    Conclusion: Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV versus PO agents. More research is necessary to determine optimal time to PO antibiotic switch.

    Kimberly Claeys, PharmD, BCPS1, Nora Loughry, BS2, Sanjay Chainani, BS2, Surbhi Leekha, MBBS, MPH3 and Emily Heil, PharmD, BCPS-AQID1, (1)Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, (2)University of Maryland School of Medicine, Baltimore, MD, (3)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD

    Disclosures:

    K. Claeys, Nabriva: Scientific Advisor , Consulting fee . Melinta: Scientific Advisor , Consulting fee .

    N. Loughry, None

    S. Chainani, None

    S. Leekha, None

    E. Heil, ALK-Abelló: Grant Investigator , Research grant .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.