Implementation of an Early Transition to Oral Antibiotics for Patients With Nonstaphylococcal Bacteremia via...

Oral antibiotics are effective in treating uncomplicated bloodstream infections (BSIs), but they are underused. The objective of this study was to evaluate the impact of a standardized antimicrobial stewardship intervention for early transition to oral antibiotics ("oral transition") for patients with uncomplicated BSIs.

A quasi-experimental study was conducted before and after implementation of a standardized stewardship intervention for patients with uncomplicated non-staphylococcal BSI over a 4-month period. Rates of oral transition and clinical outcomes were compared before and after intervention. The primary outcome was the rate of oral transition. Clinical failure (relapsed bacteremia, infection-attributable death, or new deep-seated infection with the same BSI organism) was a secondary outcome.

A total of 187 and 177 BSIs were evaluated before and after the intervention, respectively. Overall, 44% (82 of 187) and 43% (76 of 177) met pre-specified criteria for oral transition. Overall oral transition rates increased from 59% (48 of 82) before to 93% (71 of 76) after intervention (P < .01). Baseline characteristics, including severity of illness, underlying diseases, and the BSI source, were similar between groups. Clinical failure occurred within 90 days in 7% (6 of 82) and 7% (5 of 76) of patients in the pre- and post-intervention groups, respectively. The total mean antibiotic duration was shorter in the post-intervention group (10.76 vs 12.15 in the pre-intervention group; P = .02). Secondary outcomes, including length of stay, 30-day readmission rate, and antibiotic adverse events, were similar between groups.

The implementation of a real-time antimicrobial stewardship intervention resulted in an increased rate of transition to oral antibiotics and fewer overall days of therapy, without an observed difference in clinical or safety outcomes.