scholarly journals 219. Outcomes with Low- vs. High-bioavailability Oral Antibiotics in Treatment of Uncomplicated Gram-Negative Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S218-S218
Author(s):  
Ashley L Cubillos ◽  
Elisabeth Chandler ◽  
Ian P Murphy ◽  
Robert Castro
Keyword(s):  
Treatment Failure ◽  
Oral Therapy ◽  
Definitive Treatment ◽  
Common Source ◽  
Beta Lactams ◽  
Gram Negative ◽  
Oral Agents ◽  
Number Of Patients ◽  
Step Down ◽  
High Bioavailability

Abstract Background High-bioavailability (HIGH-BIO) oral agents (i.e. trimethoprim-sulfamethoxazole, fluoroquinolones) are increasingly utilized for definitive treatment of uncomplicated gram-negative (UGN) bloodstream infections (BSI). Literature supports use of HIGH-BIO agents as step-down therapy, but few studies have assessed use of low-bioavailability (LOW-BIO) agents (i.e. beta-lactams). Increased recurrence of BSI has been associated with LOW-BIO agents; suboptimal dosing of beta-lactam agents may have impacted outcomes. Trials have not assessed whether high-dose beta-lactams (HD-BL) improve clinical outcomes over low-dose beta-lactams (LD-BL) for UGN BSI. Methods This retrospective cohort study conducted between December 2016 and December 2020 included adults with UGN BSI administered oral step-down therapy for at least 1/3rd the total antibiotic duration. The primary outcome was incidence of treatment failure of HIGH-BIO compared to LOW-BIO agents within 90 days of completing oral therapy. Treatment failure was a composite of all-cause mortality, recurrent BSI, reinfection of the primary site, or transition to IV antibiotics after initiating oral therapy. Secondary outcomes were incidence of treatment failure of HIGH-BIO compared to HD-BL agents, and of HD-BL compared to LD-BL agents. Results Of 225 patients, 67 (29.8%) received a HIGH-BIO and 158 (70.2%) a LOW-BIO agent; of those in the LOW-BIO arm 126 (79.7%) received a HD-BL. The most common source of BSI was urinary (202 [89.8%]); transition to oral therapy occurred after a mean of 5 ± 2.39 days. No difference in treatment failure was observed (8 [11.9%] HIGH-BIO vs. 25 [15.8%] LOW-BIO, P = 0.45). A numerically higher number of patients in the LOW-BIO arm had recurrent BSI (4 [2.5%] LOW-BIO vs. 0 [0%] HIGH-BIO, P = 0.18). No difference in treatment failure was observed between HIGH-BIO and HD-BL agents (8 [11.9%] vs. 20 [15.9%], P = 0.46), or HD-BL and LD-BL agents (20 [15.9%] vs. 5 [15.6%], P = 0.97). Conclusion No difference in treatment failure was observed between groups; further study is needed due to failure to reach statistical power. A numerical trend towards increased recurrence of BSI was observed with LOW-BIO agents. Beta-lactams may be reasonable for step-down therapy of UGN BSI if HIGH-BIO agents are contraindicated. Disclosures All Authors: No reported disclosures

scholarly journals 166. Comparison of Oral Fluoroquinolones to Alternative Oral Agents for Definitive Step-Down Therapy in Gram-Negative Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S107-S108
Author(s):  
Christian Y Cho ◽  
Caroline Dillon ◽  
Dustin R Carr ◽  
Thomas L Walsh ◽  
Matthew Moffa ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Small Sample Size ◽  
Bloodstream Infections ◽  
Small Sample ◽  
Definitive Treatment ◽  
Failure Rates ◽  
Similar Treatment ◽  
Gram Negative ◽  
Oral Agents ◽  
Step Down

Abstract Background During the management of Gram-negative bloodstream infections (GN BSIs), definitive oral step-down therapy is often utilized. Fluoroquinolones (FQs) are commonly utilized due to excellent bioavailability; however, comparative evidence to oral trimethoprim/sulfamethoxazole (TMP/SMX) or β-lactams (BLs) are limited. Methods This multicenter, retrospective cohort included patients ≥18 years of age who had a GN BSI and received oral FQ, BL, or TMP/SMX as definitive oral step-down therapy for >33% of their total treatment duration. Patients were excluded if received ˂7 days or >17 days of total therapy, or had polymicrobial bacteremia. The primary outcome was treatment failure within 90 days. Treatment failure was a composite endpoint including both all-cause mortality and recurrence of infection. Secondary outcomes included all-cause and infection-related readmissions at 30 days. Results A total of 220 patients were included (FQ n = 106, BL n = 96, SMX/TMP n = 18). Patients were elderly (median age 70 years; IQR 59–79) and had a median Pitt bacteremia score of 1 (IQR 0–2). The most common pathogens were E. coli (58.2%) and K. pneumoniae (17.3%) and the primary source of infection was urinary (70%). Majority of BL use consisted of cephalexin (44.7%) and cefuroxime (21.3%) while FQ use was mostly ciprofloxacin (69.8%). Infectious diseases consultations were associated with 52.8%, 39.6%, and 72.2% of the prescribed FQ, BL, and SMX/TMP, respectively. Overall median intravenous, oral, and total effective antibiotic durations were 3.9, 9, and 13 days, respectively, and were similar between each group. Ninety day treatment failure rates were 9.5% in the FQ group vs. 14.6% in the BL group (P = 0.27) and 0% in the TMP/SMX group (P = 0.35). All-cause and infection-related readmissions were similar between FQ, BL, and TMP/SMX: (25.5%, 27.1%, 16.7%; P = 0.73) and (4.7%, 5.2%, 5.6%; P = 1.0), respectively. Conclusion We identified similar treatment failure rates between oral FQs, BLs, and TMP/SMX. Oral step-down therapy with BLs may be a promising FQ-sparing option for the definitive treatment of GN BSIs. Limitations to TMP/SMX efficacy should be interpreted with caution due to the small sample size. Further investigations into optimal and tolerable oral dosing of such agents are needed. Disclosures All authors: No reported disclosures.

scholarly journals 271. Clinical Outcomes Treating Gram-Negative Bacteremia with Oral Beta-Lactams vs. Trimethoprim-Sulfamethoxazole or Fluoroquinolone Step-Down Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Emily Sinclair ◽  
Jeremy J Frens ◽  
Dustin Zeigler ◽  
Megan Mccarthy ◽  
Roopali Sharma
Keyword(s):  
Clinical Outcomes ◽  
Average Length ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Gram Negative ◽  
Total Length ◽  
Oral Agents ◽  
Significant Difference ◽  
Gram Negative Bacteremia ◽  
Step Down

Abstract Background Recently, studies about gram-negative bacteremia have shown that shorter courses and early step-down therapy with oral agents have equivalent outcomes compared to longer courses with intravenous therapy. The question remains, however, as to which oral agents may be most appropriate for oral conversion therapy. At Cone Health it has been common practice to de-escalate to oral beta-lactams due to local susceptibility patterns and safety concerns with fluoroquinolones. This study retrospectively evaluated the 30-day clinical outcomes of patients treated with oral beta-lactams as step-down therapy vs. fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMX). Methods In this IRB approved, retrospective review, 200 patients with gram-negative rod bacteremia were screened. Sixty-seven patients were excluded due to inpatient mortality (17), transfer to another facility (7), hospice care (6), or receipt of intravenous antibiotics only (37). The most common organism isolated was E. coli at 57% (75/133) and a majority of cases had a genitourinary source, 79/133 (59%). The primary endpoints were 30-day readmission and mortality. Secondary endpoints included total length of antibiotic therapy and length of IV therapy. Results Of the 133 patients included, 101 (76%) received an oral beta-lactam and 32 (24%) received either a fluoroquinolone or TMP-SMX. In the beta-lactam group 22/101 (21.8%) were re-admitted within 30-days compared to 5/32 (15.6%) in the fluoroquinolone and TMP-SMX group (p=0.412). Each group had one patient re-admitted due to recurrence of bacteremia. The majority of patients in the beta-lactam group were re-admitted for a non-infectious reason (82%). Only 1 (1%) patient in the beta-lactam group died within 30 days of discharge compared to 2 (6%) in the fluoroquinolone group (p=0.165). Average total length of therapy in the beta-lactam group was 12.8 days compared to 14 days in the fluoroquinolone and TMP-SMX group (p=0.065). Average length of IV therapy was 3 days in the beta-lactam group and 4 days in the fluoroquinolone and TMP-SMX group (p=0.99). Conclusion At our institution, we have not noted any significant difference in 30-day bacteremia recurrence or mortality between those who receive oral beta-lactams or fluoroquinolones/TMP-SMX. Disclosures All Authors: No reported disclosures

scholarly journals 965. The Efficacy of Oral Β-lactam Antibiotics as Step-down Therapy for Acute Pyelonephritis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S30-S31 ◽  
Author(s):  
Athena L V Hobbs ◽  
Vagish Hemmige ◽  
Theresa Jaso ◽  
Katie Lutat ◽  
Katherine M Shea
Keyword(s):  
Acute Pyelonephritis ◽  
Treatment Success ◽  
Length Of Hospital Stay ◽  
Urinary System ◽  
Oral Agent ◽  
Oral Agents ◽  
Number Of Patients ◽  
Alternative Agent ◽  
Step Down ◽  
The Impact

Abstract Background Often, oral β-lactams have been avoided for the treatment of pyelonephritis due to data suggesting lower efficacy vs. currently recommended therapy. However, increasing resistance and concerns for collateral damage of primarily recommended oral agents have increased interest in the use of oral β-lactams for the treatment of pyelonephritis. Authors sought to assess the impact of oral step-down β-lactam therapy compared with an alternative oral agent (fluoroquinolone or trimethoprim-sulfamethoxazole) in patients with acute pyelonephritis requiring hospitalization. Methods This is an IRB-approved, multicenter, retrospective study of hospitalized patients with acute pyelonephritis in six hospitals within two healthcare systems who received an IV cephalosporin followed by step-down therapy with either a β-lactam or an alternative agent (i.e., fluoroquinolone or trimethoprim-sulfamethoxazole). We theorize that oral β-lactams are noninferior to alternative oral agents for step-down therapy for pyelonephritis requiring hospitalization. Treatment success was defined as lack of 30-day urinary system-related re-admission. We calculated that 89 patients were required in each group to achieve 80% power with a noninferiority margin of 15% and assuming a cure rate of 85% as reported in previous literature. Results A total of 188 patients were included in the study; 115 and 73 who received an oral β-lactam and an alternative oral agent, respectively. There was no difference in treatment success when comparing the two groups (113 [98%] vs. 70 [96%]; P = 0.38). The mean length of hospital stay, number of patients treated with ceftriaxone inpatient, and the duration of IV therapy was the same in both groups, though mean duration of oral therapy was longer in the oral alternative group compared with the oral β-lactam group (9.5 [+ 3.7] vs. 8.2 [+ 2.7] days, respectively; P = 0.02). Baseline characteristics other than mean age were the same, as reported in Table 1. Conclusion When using 30-day urinary system-related readmission as a surrogate for treatment success, we found no difference between β-lactams vs. alternative agents for oral step down therapy for pyelonephritis requiring hospitalization. Disclosures All Authors: No reported Disclosures.

Impact of reflex fosfomycin susceptibility testing on the utilization of carbapenems for definitive extended-spectrum β-lactamase Escherichia coli urinary tract infection treatment

2020 ◽  
Vol 77 (Supplement_4) ◽  
pp. S105-S110
Author(s):  
Kevin Deemer ◽  
Jonathan Grey ◽  
Christopher Fronczek ◽  
Kerry Marr
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Definitive Treatment ◽  
E Coli ◽  
Extended Spectrum ◽  
Oral Agents ◽  
Days Of Therapy ◽  
Step Down

Abstract Purpose A protocol was started within a large health system to automatically test all confirmed extended-spectrum beta-lactamase (ESBL)–producing Escherichia coli urine isolates for susceptibility to fosfomycin, an antibiotic not routinely included in such testing in most institutions. This study assessed the effectiveness of the protocol at reducing carbapenem use for the definitive treatment of ESBL E. coli urinary tract infection (UTI) through several endpoints. Methods Eighty and 99 patients were compared pre- and postintervention, respectively. The primary outcome was the proportion of patients who received definitive carbapenem therapy. Key secondary outcomes included median total carbapenem days of therapy (DOT), discharge on intravenous UTI antibiotics, and median total antibiotic DOT. Results Preprotocol vs postprotocol definitive carbapenem use was seen in 59 of 80 patients (73.8%) and 71 of 99 patients (71.7%) (95% confidence interval [CI] for difference, -11.1% to 15.1%; P = 0.76). The rates of step-down to oral agents pre- and postintervention were 15 of 59 (25.4%) and 35 of 71 (49.3%) (P = 0.004). Median carbapenem DOT in those receiving carbapenems decreased from 8 to 4 days (95% CI, -5 to -1 days; P = 0.001). Median total DOT decreased from 10 to 8 days (95% CI, -3 to -1 days; P = 0.002). Conclusion Implementation of a laboratory policy to automatically test ESBL positive E. coli for fosfomycin susceptibility did not reduce the percentage of patients receiving at least 1 dose of carbapenem treatment. It did result in a larger percentage reduction in step-down use of intravenous antibiotics for UTI prior to discharge, reduction in carbapenem DOT, and reduction in total antibiotic DOT.

scholarly journals 165. Comparative Effectiveness of Oral Fluoroquinolones vs. β-Lactams for the Treatment of Patients with Enterobacteriaceae Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S107-S107
Author(s):  
Lauren Bjork ◽  
Teri Hopkins ◽  
Linda Yang ◽  
Christopher R Frei ◽  
Xavier Jones ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Total Duration ◽  
Bloodstream Infections ◽  
Source Control ◽  
Definitive Treatment ◽  
Oral Antibiotic ◽  
Oral Agents ◽  
Definitive Therapy

Abstract Background Fluoroquinolones (FQ) are associated with unacceptable rates of adverse drug events (ADE) and drug resistance. Safe and effective alternative oral agents are needed for definitive treatment of Enterobacteriaceae bloodstream infections (BSI). This study aims to determine whether treatment failure rates were similar in patients who received FQ or β-lactams (BL) for stepdown treatment of Enterobacteriaceae BSI. Methods We conducted a retrospective cohort study comparing oral BL vs. FQ as definitive therapy for patients with BSI due to Escherichia coli, Klebsiella spp., or Proteus spp. Eligible patients were ≥18 years old with a monomicrobial BSI treated with a single definitive oral antibiotic. Patients with a total antibiotic treatment duration of <6 or >21 days were excluded. Groups were matched based on age and gender. The primary outcome was treatment failure defined as recurrence or all-cause mortality within 90 days with a 10% non-inferiority margin. Secondary outcomes were death or recurrence within 30 and 90 days, symptomatic urinary tract infection (UTI) or BSI within 30 days, and the safety outcome of antibiotic-related ADE. Results The average age was 68 years, with 94% males. In the BL group, 80% had a urinary source of infection vs. 69% of the FQ group. The majority of patients had source control (88% of BL group vs. 83% of FQ group). The most common pathogens were E. coli (66%) and K. pneumoniae (24%). Cefpodoxime (71%) and ciprofloxacin (85%) were the most commonly used oral antibiotics. The average duration of oral therapy was 9.2 vs. 9.6 days and total duration was 14.4 vs. 13.9 days in the BL vs. FQ group, respectively. The primary outcome occurred in 15.4% of the BL group vs. 12.3% of the FQ group (P = 0.8002, RR = 0.80, 95% CI = 0.33–1.90). No deaths were directly attributed to infection. Symptomatic UTI or BSI within 30 days occurred in 20% of BL patients vs. 21.5% of FQ patients (P = 1.0000, RR = 1.07, 95% CI = 0.55–2.11). Mortality or recurrence at 30 days were similar between groups (4.6% of BL group vs. 9.2% of FQ group, P = 0.4920, RR = 2.00, 95% CI = 0.52–7.66). One FQ patient experienced an antibiotic-related ADE (C. difficile infection). Conclusion BL are non-inferior to FQ and appear to be as effective for oral step-down treatment of Enterobacteriaceae BSI without the associated risks. Disclosures All authors: No reported disclosures.

scholarly journals Practice Patterns of Infectious Diseases Physicians in Transitioning From Intravenous to Oral Therapy in Patients With Bacteremia

2019 ◽  
Vol 7 (12) ◽  
Author(s):  
Duane R Hospenthal ◽  
C Dustin Waters ◽  
Susan E Beekmann ◽  
Philip M Polgreen
Keyword(s):  
Infectious Diseases ◽  
Oral Therapy ◽  
Source Control ◽  
Oral Antibiotics ◽  
Emerging Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia ◽  
Rapid Transition

Abstract Background Bacteremia in adult patients has traditionally been treated with extended courses of intravenous antibiotics. Data on the use of (or rapid transition to) oral therapy are limited. Methods Adult infectious disease physicians participating in the Infectious Diseases Society of America Emerging Infections Network (EIN) were surveyed regarding their use of oral antibiotics in patients with bacteremia. Respondents were asked to assume that patients were hemodynamically stable, recovered bacteria were susceptible to potential antibiotics, adequate source control had been achieved, and patients had adequate gastrointestinal absorption. Variables of specific bacteria, oral agent, and associated infection were included. Results A total of 655 (50%) of 1321 EIN participants responded. Under certain conditions, 88% would transition patients with Gram-negative bacteremia to complete a course of therapy with oral antibiotics; 71% would transition patients with Gram-positive bacteremia to oral agents. Only 78 (12%) respondents would not treat any bacteremic patient with oral agents. Most respondents (≥75%) were comfortable treating infections secondary to Enterobacteriaceae, Salmonella, Pseudomonas, Stenotrophomonas, Streptococcus pneumoniae, and β-hemolytic streptococci with oral agents. Fewer than 20% endorsed use of oral antibiotics for Staphylococcus aureus or in cases of endocarditis. Fluoroquinolones and trimethoprim-sulfamethoxazole were the preferred agents in Gram-negative bacteremia; linezolid and β-lactams were the preferred agents in Gram-positive bacteremia. Conclusions In select circumstances, the majority of respondents would transition patients to oral antibiotics, in both Gram-negative and Gram-positive bacteremia. Most agreed with the use of oral agents in Gram-negative bacteremia caused by Enterobacteriaceae, but they would not use oral agents for Gram-positive bacteremia caused by S aureus or in endocarditis.

scholarly journals 1022. Is it Time to Re-Evaluate Oral Β-Lactam Antibiotics for Step-Down Therapy of Uncomplicated Gram-Negative Bacteremia?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S360-S360
Author(s):  
Michael McAlister ◽  
Dusten T Rose ◽  
Theresa Jaso ◽  
Brian Olivares ◽  
F Parker Hudson
Keyword(s):  
Total Duration ◽  
Hospital Length Of Stay ◽  
Definitive Treatment ◽  
Causative Organism ◽  
Resistant Organism ◽  
Common Source ◽  
Oral Antibiotic ◽  
E Coli ◽  
Significant Difference ◽  
Step Down

Abstract Background Bloodstream infections (BSI) due to Enterobacteriaceae often require empiric intravenous (IV) antibiotics. Oral antibiotics for the definitive treatment of these infections have been reserved to antibiotics with “high” oral bioavailability, mainly fluoroquinolones (FQ). Safety concerns and increasing resistance associated with FQ has modified clinical practice to identify alternative oral therapies. Select β-lactam (BL) antibiotics are well-tolerated, have moderately high bioavailability, and possess in-vitro activity against Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Proteus mirabilis (P. mirabilis). Limited evidence exists for oral BL step-down therapy for definitive treatment of BSI due to these organisms. Methods This retrospective cohort study compares clinical outcomes of patients treated with oral BL antibiotics to those who received oral FQ or trimethoprim/sulfamethoxazole (TS) for the treatment of BSI due to E. coli, K. pneumoniae, and P. mirabilis. The primary outcome is a composite of 30-day all-cause mortality, 30-day readmission due to recurrence, and/or change in oral antibiotic therapy. Secondary endpoints include 90-day development of Clostridium difficile infection, 90-day all-cause readmission, hospital length of stay (LOS), and 90-day recovery of a multi-drug-resistant organism. Results Nine hundred eighty-one patients were screened and 397 adult patients were included. Excluded patients: IV only (n = 291), polymicrobial blood culture (n = 112), immunocompromised (n = 61), other (n = 120). Two-hundred patients received oral step-down therapy with a BL, and 197 with either an FQ or TS. E. coli was the causative organism for most patients in both groups, and urinary tract was the most common source of BSI. The median total duration of therapy was 14 days in both groups. There was no significant difference in the primary composite endpoint (7% vs. 5.6%, P = 0.561). There was no mortality or differences in secondary outcomes, except LOS (6 vs. 5 days, P = 0.043). Conclusion Utilization of oral BL for the step-down therapy of uncomplicated BSI due to E. coli, K. pneumoniae, and P. mirabilis did not result in worse outcomes compared with those receiving oral FQ or TS. Disclosures All authors: No reported disclosures.

scholarly journals 1072. Streamlining to Oral β-Lactam vs. Fluoroquinolone as Definitive Therapy for Enterobacteriaceae Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S321-S321 ◽  
Author(s):  
Karen Fong ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
John Papadopoulos ◽  
Vinh Pham ◽  
...  
Keyword(s):  
Oral Therapy ◽  
Oral Treatment ◽  
Treatment Strategies ◽  
Definitive Treatment ◽  
Source Of Infection ◽  
Definitive Therapy ◽  
Comorbidity Index ◽  
Secondary Outcomes ◽  
Infectious Diseases Consultation ◽  
High Bioavailability

Abstract Background Oral treatment strategies for Enterobacteriaceae bacteremia (EB) are controversial, with both β-lactams (BL) and fluoroquinolones (FQ) used in clinical practice. FQ may be preferred for their high bioavailability, but other oral antibiotics are needed due to concerns of resistance and adverse effects. As an effort to facilitate antibiotic stewardship, BL should be explored as an additional oral option for EB treatment. Methods This retrospective study compared clinical characteristics and outcomes in patients with EB treated with BL vs. FQ as definitive oral therapy between January 2013 and July 2017. Adult patients diagnosed with their first incidence of EB and transitioned from IV antibiotics to either study antibiotic class were included. Primary and secondary outcomes assessed recurrence, collateral damage, readmission, and all-cause mortality. Results A total of 173 patients were included (BL n = 59, FQ n = 114). Median age was 70 years, Pitt bacteremia score was 2 (range 0–7), and Charlson Comorbidity Index was 5 (0–12); all were comparable between groups. Urinary source of infection was most common (57%). The majority of oral BL courses used cefpodoxime (63%). More patients in FQ vs. BL had a prior transplant (9% vs. 0%, P = 0.05), presence of abscess (11% vs. 0%, P = 0.01), and Infectious Diseases consultation (63% vs. 34%, P = 0.0001). Onset of EB in an intensive care unit was more common in BL vs. FQ (24% vs. 10%, P = 0.01). Median duration of IV and oral therapy was 5 vs. 4 days, P = 0.22 and 11 vs. 12 days, P = 0.17 in BL and FQ, respectively. Recurrence within 90 days was 7% in BL and 4% in FQ, P = 0.49 (adjusted OR 1.44, 95% CI 0.31–6.66; P = 0.64). Multivariate analysis identified liver cirrhosis (OR 16.89, 95% CI 1.06–268.32; P = 0.05) as an independent predictor of recurrence within 90 days. All secondary outcomes were similar between BL vs. FQ: superinfection within 90 days (10% vs. 9%, P = 0.76), C. difficile infection within 90 days (3% vs. 1%, P = 0.27), 30-day readmission (15% vs. 20%, P = 0.43), all-cause 30-day mortality (0% vs. 3%, P = 0.55). Conclusion In our cohort of patients with EB, clinical outcomes were similar between those treated with oral BL compared with FQ. Oral BL may be considered for definitive treatment of EB, although further investigation in larger studies is needed. Disclosures All authors: No reported disclosures.

scholarly journals 258. A Comparison of Cefprozil and Fluoroquinolones for Gram-Negative Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S128-S128
Author(s):  
Rebecca C Nolen ◽  
Emily M Shor ◽  
Anthony Lucido ◽  
Georgeanne Hodges ◽  
Alex Metzger ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Recurrent Infection ◽  
Multivariate Model ◽  
Oral Antibiotic ◽  
Gram Negative ◽  
E Coli ◽  
Gram Negative Bacteremia ◽  
Total Treatment ◽  
Antibiotic Duration ◽  
Step Down

Abstract Background Beta lactams and fluoroquinolones (FQ) have been evaluated as step-down therapy options for Gram-negative bacteremia (GNB), but the preferred oral step-down antibiotic remains unclear. Methods This retrospective, non-inferiority, cohort study included adult patients who received oral step-down therapy with cefprozil or FQ (ciprofloxacin, levofloxacin) for GNB caused by Proteus spp, Klebsiella spp, or E. coli at SSM Health St. Louis between 1/1/2016 and 2/28/2020. The primary outcome was treatment failure, defined as all-cause mortality or recurrent infection within 30 days of initial bacteremia episode. Assuming an 85% success rate, to achieve 80% power with a noninferiority margin of 15%, 71 patients were required in each arm. Multivariate logistic regression was used to evaluate factors for treatment failure. Factors evaluated for inclusion in the multivariate model were oral antibiotic, age &gt;65 years, urinary source, Pitt bacteremia score &gt;2, ICU admission, and IV antibiotics for &gt;5 days prior to step-down. Results A total of 174 patients were included— 103 received cefprozil and 71 received FQ. Most baseline characteristics were similar between groups. Patients in the cefprozil group had more ICU admissions (21.3% vs. 7%; p=0.01), had a higher mean Pitt bacteremia score (1.6 vs 0.7; p&lt; 0.001), and received a longer duration (days) of IV antibiotics prior to step-down therapy (5.2 vs 4.1; p&lt; 0.001). Mean total treatment duration (days) was similar between groups (13.1 vs 13.2; p=0.75). Cefprozil 500 mg PO BID was administered in 84.5% of cefprozil patients. Treatment failure occurred in 3.88% (4/103) of cefprozil patients compared to 1.41% (1/71) of FQ patients (mean difference -2.47%; 95% CI -7.52% to 2.58%). The rate of adverse drug reactions was significantly higher in the FQ arm (2.9% vs 12.6%; p=0.016). In the univariate model, E. coli bacteremia, Pitt bacteremia score &gt;2, and IV antibiotic duration &gt;5 days met pre-defined criteria (p&lt; 0.2) for inclusion in the multivariate model. In the multivariate analysis, these factors were not found to be significant. Conclusion Cefprozil was non-inferior to FQ in regard to treatment failure. Cefprozil is an efficacious alternative to FQ for oral step-down treatment of GNB and was associated with significantly fewer adverse effects. Disclosures All Authors: No reported disclosures

scholarly journals 1001. Evaluation of the Clinical Efficacy and Safety of Oral Antibiotic Therapy for Streptococcus spp. Bloodstream Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S297-S298 ◽  
Author(s):  
Amy Kang ◽  
Cynthia Bor ◽  
Jamie Chen ◽  
Michelle Gandawidjaja ◽  
Emi Minejima
Keyword(s):  
Antibiotic Therapy ◽  
Oral Therapy ◽  
Bloodstream Infections ◽  
Hospital Length Of Stay ◽  
Common Source ◽  
Oral Antibiotic ◽  
Efficacy And Safety ◽  
Oral Antibiotic Therapy ◽  
Definitive Therapy ◽  
Step Down

Abstract Background Despite the severity and frequency of bloodstream infections (BSI), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the efficacy and safety of step down oral antibiotics for the treatment of Streptococcus spp. BSI. Methods This was a retrospective cohort study of adult, hospitalized patients with Streptococcus spp. BSI between June 2015 and June 2017. Patients were excluded if received &lt;48 hours of antibiotic therapy or therapy was started &gt;48 hours from first positive culture. Patients were grouped by receipt of step down oral antibiotic therapy (PO group) vs. full course IV therapy (IV group) and compared for demographics, clinical course, and outcomes. The primary outcome was 30-day mortality and hospital length of stay (LOS). The secondary outcomes included 30-day recurrence of BSI and adverse events (AEs). Results One hundred ninety-five patients met inclusion criteria; median age was 51 year old, 68% were male, 57% were Hispanic, and 71% had community-onset BSI. Sixty-four (33%) were treated with step down oral therapy. The most common source of bacteremia was pneumonia (21%); 8% had endocarditis. Comorbidities were similar between the groups, with diabetes being most common (IV 22% vs. PO 19%, P = 0.29). Severity of illness measured by need for ICU admission, initial lactate level, and SOFA score was similar between the two groups. S. viridans was the most frequent pathogen isolated (IV 28% vs. PO 27%, P = 0.87). Ceftriaxone (39%) for the IV group and levofloxacin (30%) for the PO group were the most common definitive therapy prescribed. PO group received 4 days of IV therapy prior to transition to orals. The IV group had significantly higher mortality rate (11% vs. 2%, P = 0.02) and longer LOS (median 9 days [IQR 5–18] vs. 5 days [4–7.75], P ≤ 0.01) compared with the PO group. 30-day recurrence (IV 2% vs. PO 5%, P = 0.40) and AEs (IV 2% vs. PO 3%, P = 0.60) were similar between the two groups. Conclusion In Streptococcus spp. BSI, step down oral antibiotic therapy was associated with a significantly shorter LOS compared with IV only therapy without compromise of clinical outcomes. Larger prospective trials evaluating step down oral therapy are warranted to confirm our results. Disclosures All authors: No reported disclosures.

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