Oral antibiotic stepdown therapy for uncomplicated streptococcal bloodstream infections.

OBJECTIVE

This study aimed to evaluate the role of oral antibiotic stepdown therapy in patients with uncomplicated streptococcal bacteremia. species are known pathogens in bloodstream infections (BSIs). Traditionally, BSIs were managed with intravenous (IV) antibiotics; however, growing literature supports oral antibiotics in invasive infections including BSIs.

DESIGN

This was a retrospective cohort study evaluating patients with streptococcal bacteremia between September 2019 and September 2021 at an academic safety-net hospital. Clinical outcomes were compared between patients completing treatment with IV antibiotics versus an oral stepdown regimen. The primary outcome, clinical failure, was a composite of BSI recurrence and infection-related readmission.

PATIENTS

Adult patients with at least one positive blood culture for any species were included. Patients with polymicrobial BSIs or complicated bacteremia were excluded.

RESULTS

155 patients were included, 77 (49.7%) received a course of IV antibiotics and 78 (50.3%) received an oral antibiotic stepdown regimen. Clinical failure was not different between the IV and oral groups (15.6% vs. 15.4%, respectively; OR .99 [95% CI, .41 to 2.35]). No differences were observed in 30-day all-cause mortality. Patients that received oral antibiotics had a significantly shorter hospital length of stay by 6 days (6 vs 12 d, < .01).

CONCLUSIONS

Our results suggest that an oral stepdown regimen for uncomplicated streptococcal BSIs is associated with similar outcomes compared to IV antibiotics. Furthermore, oral antibiotics may offer reduced length of stay and avoidance of outpatient central line placement in patients with uncomplicated streptococcal BSIs.