Little evidence is available to guide the treatment of gram-negative bacteremia. In practice, there are varying degrees of comfort amongst providers with the use of highly bioavailable oral (PO) antibiotics. The purpose of this study was to evaluate the outcome of patients treated with definitive PO ciprofloxacin and those treated with intravenous (IV) antibiotics.
This was a single center retrospective cohort study at Froedtert & the Medical College of Wisconsin for hospitalized patients with at least one positive blood culture for a gram-negative organism between January 2015 and December 2017. Treatment failure was a composite of all-cause mortality and recurrent bacteremia or recurrent primary site infection. The primary outcome was 90-day treatment failure. Secondary outcomes included 30-day treatment failure, 30- and 90-day all-cause mortality, and 30- and 90-day recurrent infection.
Ninety-eight patients in the IV group and 103 patients in the PO group were identified. More patients in the IV group were immunosuppressed (41 vs 22%, P< 0.005). In both groups, Pitt Bacteremia scores were similar, achievement of source control was similar, urine was the most common source of bacteremia, and Escherichia coli was the predominant pathogen. Treatment failure at 90-days occurred in 16 and 2 patients (16.8 vs 1.9%, P<0.01) in the IV and PO groups, respectively. 30-day mortality was similar between both groups (4.5 vs 0%, P=0.1). At 30-days, treatment failure occurred in 6 patients in the IV group and 0 patients in the PO group (6.3 vs 0%, P=0.01). Infection recurrence at 90-days occurred in 10 and 1 patient (10.5 vs 1%, P<0.01). After adjustment for potential confounders via logistic regression analysis, no characteristics correlated with treatment failure other than IV therapy (P=0.001).
Oral ciprofloxacin was an effective option for the treatment of gram-negative bacteremia.