Department of Pharmacy, Froedtert Hospital, Milwaukee, WI, USA.
Department of Pharmacy, Froedtert Hospital, Milwaukee, WI, USA.
Diagn Microbiol Infect Dis. 2023 Dec;107(4):116068. doi: 10.1016/j.diagmicrobio.2023.116068. Epub 2023 Aug 21.
Bloodstream infections traditionally are treated with intravenous (IV) therapy. This study's purpose is to evaluate if oral step-down therapy is noninferior to IV therapy for gram-positive bloodstream infections (GP-BSIs). This retrospective cohort study included patients who received IV therapy and those who received oral step-down therapy for a nonstaphylococcal GP-BSI from 2017 to 2019. The primary endpoint was a composite outcome of 90-day all-cause mortality and clinical failure. A total of 308 patients were included (n = 94, oral; n = 214, IV). The oral step-down group had a lower incidence of 90-day clinical failure (9% vs 14%; P < 0.001). The IV group had a longer hospital stay (4 vs 6 days, P < 0.001); however, there were no significant differences in secondary outcomes. Bivariate analysis found no predictors of 90-day clinical failure. Oral step-down therapy was found to be noninferior to IV therapy.
血流感染传统上采用静脉（IV）治疗。本研究旨在评估口服降级治疗是否不劣于静脉治疗革兰阳性血流感染（GP-BSI）。这项回顾性队列研究纳入了 2017 年至 2019 年接受 IV 治疗和口服降级治疗非葡萄球菌 GP-BSI 的患者。主要终点是 90 天全因死亡率和临床失败的复合结局。共纳入 308 例患者（n=94，口服；n=214，IV）。口服降级组 90 天临床失败发生率较低（9% vs 14%；P<0.001）。IV 组的住院时间较长（4 天 vs 6 天，P<0.001）；然而，次要结局无显著差异。二元分析未发现 90 天临床失败的预测因素。口服降级治疗被发现不劣于静脉治疗。
