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 <48 hours of antibiotic therapy or therapy was started >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.

scholarly journals 289. Impact of Clinician Specialty on the Use of Oral Antibiotic Therapy for Definitive Treatment of Uncomplicated Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S145
Author(s):  
Jasmine R Marcelin ◽  
Mackenzie R Keintz ◽  
Jihyun Ma ◽  
Erica J Stohs ◽  
Bryan Alexander ◽  
...  
Keyword(s):  
Social Media ◽  
Soft Tissue ◽  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Definitive Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Gram Positive ◽  
Oral Antibiotic Therapy

Abstract Background No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat uncomplicated bloodstream infections (uBSIs) and practices may vary depending on clinician specialty and experience. Methods An IRB-exempt web-based survey was emailed to Nebraska Medicine clinicians caring for hospitalized patients, and widely disseminated using social media. The survey was open access and once disseminated on social media, it was impossible to ascertain the total number of individuals who received the survey. Chi-squared analysis for categorical data was conducted to evaluate the association between responses and demographic groups. Results Of 275 survey responses, 51% were via social media, and 94% originated in the United States. Two-thirds of respondents were physicians, 16% pharmacists, and infectious diseases clinicians (IDC) represented 71% of respondents. The syndromes where most were comfortable using OAT routinely for uBSI were urinary tract infection (92%), pneumonia (82%), pyelonephritis (82%), and skin/soft tissue infections (69%). IDC were more comfortable routinely using OAT to treat uBSIs associated with vertebral osteomyelitis and prosthetic joint infections than non-infectious diseases clinicians (NIDC), but NIDC were more likely to report comfort with routine use of OAT to treat uBSIs associated with meningitis and skin/soft tissue infections. IDC were more likely to report comfort with routine use of OAT for uBSIs due to Enterobacteriaceae and gram-positive anaerobes, while NIDC were more likely to be comfortable with routinely using OAT to treat uBSIs associated with S. aureus, coagulase-negative staphylococci and gram-positive bacilli. In one clinical vignette of S. aureus uBSI due to debrided abscess, 11% of IDC would be comfortable using OAT vs 28% of NIDC; IDC were more likely to report routinely repeating blood cultures (99% vs 83%, p< 0.05). Figure 1: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific syndromes Figure 2: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific organisms Conclusion Considerable variation in comfort using OAT for uBSIs among IDC vs NIDC exists, highlighting opportunities for IDC to continue to demonstrate their value in clinical practice. Understanding the reasons for variability may be helpful in creating best practice guidelines to standardize decision making. Disclosures All Authors: No reported disclosures

scholarly journals 159. Comparing Clinical Cure and Patient Outcomes Between Intravenous Therapy and Intravenous (IV)-to-Oral (PO) Step-down Therapy for Treatment of Gram-Negative Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S105-S105
Author(s):  
Kelsey Williams ◽  
Riane Ghamrawi ◽  
Sheila Takieddine ◽  
Peter Grubbs ◽  
Maggie Powers-Fletcher ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Medical Center ◽  
Univariate Analysis ◽  
Bloodstream Infections ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Gram Negative ◽  
Step Down ◽  
Cure Rates

Abstract Background There is a paucity of evidence surrounding optimal prescribing practices for the treatment of Gram-negative bloodstream infections (GNBSI). This study aimed to assess the appropriateness of IV-to-PO step-down therapy in the treatment of GNBSI. Methods A retrospective cohort study was conducted at the University of Cincinnati Medical Center and West Chest Hospital and included subject’s ≥18 years of age with GNBSI caused by Enterobacteriaceae spp. or Pseudomonas aeruginosa. The primary objective was to compare clinical cure rates between IV-only and IV-to-PO therapy, and to further assess differences in clinical cure rates amongst oral antibiotics of high, moderate, and low bioavailability. The study also aimed to identify factors associated with clinical cure, hospital length of stay, and emergence of multi-drug-resistant organisms (MDRO). Results Amongst 215 subjects screened, 99 subjects were included and 64 subjects met criteria for clinical cure. In the univariate analysis, the IV-to-PO group had a higher percentage of clinical cure than IV only therapy (82% vs. 48%, P = 0.001). Of note, the two study groups were significantly different in regards to intensive care status, Pitt bacteremia score, and primary site of infection. Upon further analysis, data from the multivariate logistic regression revealed that critical illness was the only significant factor that negatively impacted clinical cure (OR = 0.208; 95% CI 0.04–0.99; P = 0.049). A total of 49 subjects received oral antibiotics. Majority of patients (82%) in the IV-to-PO group received a moderately bioavailable oral antibiotic. No difference in respect to clinical cure rate was found between the three PO antibiotic bioavailability groups (P = 0.346). The median duration of hospital stay was shorter in the IV-to-PO compared with IV alone group (4 days vs. 9.5 days, respectively, P ≤ 0.001). There was a trend in emergence of MDROs with IV therapy compared with IV-to-PO therapy (10% vs. 2%, P = 0.204). Conclusion IV-to-PO stepdown therapy compared with IV therapy alone was noninferior in clinical cure rates in the treatment of GNBSI and may result in fewer hospital days and less emergence of multidrug-resistant organisms. These conclusions are limited by significant differences in severity of illness between groups in this study. Disclosures All authors: No reported disclosures.

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 Optimizing the Management of Uncomplicated Gram-Negative Bloodstream Infections: Consensus Guidance Using a Modified Delphi Process

2021 ◽  
Vol 8 (10) ◽  
Author(s):  
Emily L Heil ◽  
Jacqueline T Bork ◽  
Lilian M Abbo ◽  
Tamar F Barlam ◽  
Sara E Cosgrove ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Oral Antibiotic ◽  
Gram Negative ◽  
Modified Delphi ◽  
Oral Antibiotic Therapy ◽  
Consensus Statements ◽  
Definition Of

Abstract Background Guidance on the recommended durations of antibiotic therapy, the use of oral antibiotic therapy, and the need for repeat blood cultures remain incomplete for gram-negative bloodstream infections. We convened a panel of infectious diseases specialists to develop a consensus definition of uncomplicated gram-negative bloodstream infections to assist clinicians with management decisions. Methods Panelists, who were all blinded to the identity of other members of the panel, used a modified Delphi technique to develop a list of statements describing preferred management approaches for uncomplicated gram-negative bloodstream infections. Panelists provided level of agreement and feedback on consensus statements generated and refined them from the first round of open-ended questions through 3 subsequent rounds. Results Thirteen infectious diseases specialists (7 physicians and 6 pharmacists) from across the United States participated in the consensus process. A definition of uncomplicated gram-negative bloodstream infection was developed. Considerations cited by panelists in determining if a bloodstream infection was uncomplicated included host immune status, response to therapy, organism identified, source of the bacteremia, and source control measures. For patients meeting this definition, panelists largely agreed that a duration of therapy of ~7 days, transitioning to oral antibiotic therapy, and forgoing repeat blood cultures, was reasonable. Conclusions In the absence of professional guidelines for the management of uncomplicated gram-negative bloodstream infections, the consensus statements developed by a panel of infectious diseases specialists can provide guidance to practitioners for a common clinical scenario.

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