Uncomplicated Streptococcal Bacteremia: The Era of Oral Antibiotic Step-down Therapy?

Waked, Rami; Craig, Wendy Y.; Mercuro, Nicholas J; Wungwattana, Minkey; Wood, Emily; Rokas, Kristina

doi:10.1016/j.ijantimicag.2023.106736

Cited by 11 publications

(18 citation statements)

References 28 publications

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“…In this multi-hospital retrospective cohort study, transitioning patients with uncomplicated streptococcal BSIs from intravenous to oral antibiotics was associated with a shorter HLOS without increasing the risk of treatment failure. These results support a growing shift in favor of partial oral antibiotic therapy for uncomplicated Streptococcus species BSIs [ 15 , 16 , 17 ]. The previous three studies similarly demonstrated shorter HLOSs and a comparable mortality associated with partial oral versus standard intravenous therapy for the treatment of BSIs caused by Streptococcus species [ 15 , 16 , 17 ].…”

Section: Discussionsupporting

confidence: 71%

“…These results support a growing shift in favor of partial oral antibiotic therapy for uncomplicated Streptococcus species BSIs [ 15 , 16 , 17 ]. The previous three studies similarly demonstrated shorter HLOSs and a comparable mortality associated with partial oral versus standard intravenous therapy for the treatment of BSIs caused by Streptococcus species [ 15 , 16 , 17 ]. Across all four studies, the most common sources of infection were skin and soft tissue and the respiratory tract [ 15 , 16 , 17 ].…”

Section: Discussionsupporting

confidence: 71%

“…The previous three studies similarly demonstrated shorter HLOSs and a comparable mortality associated with partial oral versus standard intravenous therapy for the treatment of BSIs caused by Streptococcus species [ 15 , 16 , 17 ]. Across all four studies, the most common sources of infection were skin and soft tissue and the respiratory tract [ 15 , 16 , 17 ]. Given the non-randomized design of these studies, there was a reasonable concern regarding the potential selection of patients with favorable prognoses and a better initial response to antibiotic therapy for transitioning to partial oral regimens [ 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 85%

“…Across all four studies, the most common sources of infection were skin and soft tissue and the respiratory tract [ 15 , 16 , 17 ]. Given the non-randomized design of these studies, there was a reasonable concern regarding the potential selection of patients with favorable prognoses and a better initial response to antibiotic therapy for transitioning to partial oral regimens [ 15 , 16 , 17 ]. To our knowledge, the current study was the first to use ECFC to adjust for the initial response to therapy around the time of transitioning from intravenous to oral antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…However, the utilization of partial oral antibiotic therapy for the treatment of streptococcal BSIs is a relatively a new concept, and the susceptibility of Streptococcus species to penicillin lends to different oral options than most Gram-negative BSIs. Although oral antibiotics have been used in the treatment of streptococcal BSIs, their specific role in therapy remains unclear [ 5 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Broermann,

Al-Hasan,

Withers

et al. 2023

Microorganisms

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This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (−2.23 days, 95% CI −3.53, −0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.

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