A Retrospective Analysis of Intravenous vs Oral Antibiotic Step‐Down Therapy for the Treatment of Uncomplicated Streptococcal Bloodstream Infections

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Abstract
Evidence supporting intravenous‐to‐oral (IV‐to‐PO) antibiotic deescalation for uncomplicated streptococcal bloodstream infections (BSIs) are limited. The objective of this study was to compare clinical outcomes of patients treated with IV‐only versus IV‐to‐PO antibiotic therapy for uncomplicated streptococcal BSIs. This was a single‐center, retrospective study of patients aged ≥18 years who received treatment for uncomplicated streptococcal BSIs from January 2017 to December 2019. Patients were excluded if they had a polymicrobial BSI, endocarditis, osteomyelitis, septic arthritis, or received antibiotic therapy for >14 days. The primary outcome was clinical failure, defined as persistent bacteremia, recurrence of bacteremia, or mortality at 30 days. Secondary outcomes included length of hospital stay, all‐cause readmissions, development of Clostridioides difficile infection, and adverse antibiotic reactions. There were 98 patients who met the inclusion criteria: 51 patients in the IV‐to‐PO therapy group and 47 patients who received IV‐only antibiotics. Streptococcus pneumoniae and beta‐hemolytic streptococci were the most common pathogens. Patients received an average of 4.4 days of IV antibiotics before being stepped down to an oral agent. Hospital length of stay (6.3 vs 12.6 days; P < .001) and total antibiotic duration of therapy (11.8 vs 13.9 days; P = .002) were significantly shorter in patients receiving IV‐to‐PO therapy. There were no clinical failures observed in patients who received IV‐to‐PO antibiotic therapy. IV‐to‐PO step‐down therapy for uncomplicated streptococcal BSIs was not associated with worse clinical outcomes compared to patients receiving IV‐only antibiotic therapy.

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