Early versus late transition to oral antibiotics in Enterobacterales bacteremia
Musa Yahia, Cassandra Falk, Raymond Yost, Abigail GeyerAbstract
Objective:
Evaluate outcomes of early versus late intravenous (IV)-to-oral antibiotic transition in patients with uncomplicated Enterobacterales bacteremia.
Design:
Multicenter, retrospective observational cohort study.
Setting:
Healthcare system with one tertiary care academic medical center and four community teaching hospitals.
Patients:
Adults with uncomplicated Enterobacterales bacteremia, clinical stability within 72 hours of antibiotic initiation, definitive source control, ability to take oral medication, and final susceptibility reports were included. The following were excluded: never received oral antibiotic; inadequate treatment duration; transitioned back to IV therapy; inappropriate antimicrobial therapy based on dosing or susceptibilities; transferred from outside institution; immunocompromised; pregnant.
Methods:
Early transition was considered IV-to-oral antibiotic transition by day 4 of therapy. The primary outcome was treatment failure within 30 days of antibiotic completion, a composite end point encompassing infection recurrence, escalation of antimicrobial therapy, infection-related re-admission, and death. Secondary outcomes included hospital length of stay and total antibiotic duration.
Results:
225 patients were included; 133 (59.1%) transitioned to oral antibiotics early and 92 (40.9%) transitioned late. There were no significant differences in the primary composite outcome of treatment failure for early transition versus late transition (6.0% vs 6.5%, P = .877). Early transition was associated with shorter median hospital length of stay (5 vs 7 d, P < .001) and total antibiotic duration (9 vs 12 d, P < .001).
Conclusion:
Early IV-to-oral antibiotic transition in patients with uncomplicated Enterobacterales bacteremia and clinical stability within 72 hours was effective with potential to reduce length of stay and total antibiotic duration.