Infectious Diseases, Maine Medical Center, Portland, Maine, USA.
Maine Health Institute for Research, Scarborough, Maine, USA.
Int J Antimicrob Agents. 2023 Mar;61(3):106736. doi: 10.1016/j.ijantimicag.2023.106736. Epub 2023 Jan 20.
The purpose of this study was to compare the clinical outcomes of adults with uncomplicated streptococcal bacteremia who received either oral (PO) step-down or continued intravenous (IV) therapy.
This was a retrospective, single-center, cohort study, including adults admitted with Streptococcal bloodstream infection between January 1, 2013, and December 31, 2020. Only patients with uncomplicated Streptococcal bloodstream infections were included. Patients who transitioned to PO therapy within 5 days from bacteremia onset were compared to patients receiving continued IV therapy. The primary outcome was clinical failure, defined by either 90-day hospital readmission or mortality. Secondary outcomes included hospital length of stay (LOS) and antibiotic-related adverse events (AAEs).
Of the 264 patients included, 42% were transitioned to PO therapy. Group B Streptococcus (22.7%) was the most common isolate. The most common sources of infection were skin and soft tissue (35%) and pulmonary (25%). Intensive care unit (ICU) stay was more common in the continued IV therapy group (22.2%) than in the PO step-down group (5.4%). The frequency of clinical failure was similar in the IV and PO groups (24.2% vs. 18.0%, P=0.23). The IV group had longer hospital LOS (median, [interquartile range (IQR)]) compared with the PO group (7 [5-13.5] vs. 4 [3-5] days, P<0.001). The incidence of AAEs was similar in the IV and PO groups (1.3% vs. 1.8%, P=0.74).
Oral antibiotic step-down therapy may be appropriate for the treatment of uncomplicated Streptococcal bacteremia, with consideration of factors such as patient comorbidities, type of infection, source control and clinical progress.
本研究旨在比较患有单纯性链球菌菌血症的成年人接受口服（PO）降阶梯或持续静脉（IV）治疗的临床结局。
这是一项回顾性、单中心队列研究，纳入 2013 年 1 月 1 日至 2020 年 12 月 31 日期间因链球菌血流感染入院的成年人。仅纳入患有单纯性链球菌菌血症的患者。从菌血症发病到开始 PO 治疗的 5 天内转为 PO 治疗的患者与接受持续 IV 治疗的患者进行比较。主要结局是临床失败，定义为 90 天内再次住院或死亡。次要结局包括住院时间（LOS）和抗生素相关不良事件（AAE）。
在纳入的 264 名患者中，42%的患者转为 PO 治疗。B 群链球菌（22.7%）是最常见的分离株。最常见的感染源是皮肤和软组织（35%）和肺部（25%）。与 PO 降阶梯组（5.4%）相比，持续 IV 治疗组（22.2%）更常见入住重症监护病房（ICU）。IV 组和 PO 组的临床失败发生率相似（24.2% vs. 18.0%，P=0.23）。与 PO 组相比，IV 组的住院 LOS 更长（中位数[四分位距（IQR）]）（7 [5-13.5] vs. 4 [3-5]天，P<0.001）。IV 组和 PO 组的 AAE 发生率相似（1.3% vs. 1.8%，P=0.74）。
口服抗生素降阶梯治疗可能适合治疗单纯性链球菌菌血症，需考虑患者合并症、感染类型、感染源控制和临床进展等因素。
