Outcomes of early oral antibiotic transition for the treatment of uncomplicated enterococcal bacteremia

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Abstract
Objective: To compare clinical outcomes in adults with uncomplicated enterococcal bacteremia treated with intravenous (IV) therapy alone versus an early oral (PO) transition and evaluate treatment characteristics and safety outcomes. Design: Retrospective cohort study between January 1, 2021, and August 1, 2024. The primary outcome was clinical cure at 90 days after antibiotic completion. Secondary outcomes included treatment failure, infection-related readmission, hospital length of stay (HLOS), and 90-day mortality. Setting: Massachusetts General Hospital and Brigham and Women’s Hospital, two tertiary care centers in Boston, MA. Patients: Adult patients with at least one positive blood culture with Enterococcus spp. Patients were excluded if they had polymicrobial or persistent bacteremia, invasive infection, incomplete source control, died before completing therapy, or received fewer than 7 days of antibiotics. Results: 209 patients were included, of which 119 received IV therapy alone and 90 underwent early PO transition. Gastrointestinal (41.6%) and genitourinary (32.1%) sources were most common, and 86 patients (41.1%) had immunocompromising conditions. Clinical cure was similar between the IV and early PO transition groups (73.9% vs 82.2%; P = .156), with no significant differences in secondary and safety outcomes. HLOS was significantly shorter in the early PO transition group (9 days vs 20 days; P < .001). Conclusion: Early PO transition appears to be a safe and effective strategy for uncomplicated enterococcal bacteremia and was associated with reduced HLOS.

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