PMID- 35127081
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220501
IS  - 2049-9361 (Print)
IS  - 2049-937X (Electronic)
IS  - 2049-9361 (Linking)
VI  - 9
DP  - 2022 Jan-Dec
TI  - Evaluation of step-down oral antibiotic therapy for uncomplicated streptococcal 
      bloodstream infections on clinical outcomes.
PG  - 20499361211073248
LID - 10.1177/20499361211073248 [doi]
LID - 20499361211073248
AB  - BACKGROUND: Despite the severity and frequency of streptococcal bloodstream 
      infections (BSIs), the effectiveness of oral definitive therapy remains unknown. 
      The objective of this study was to evaluate the clinical outcomes of step-down 
      oral antibiotics for the treatment of uncomplicated streptococcal BSIs. METHODS: 
      In this retrospective cohort study, adult patients admitted with uncomplicated 
      streptococcal BSI between June 2015 and June 2017 were included. Patients were 
      excluded if they received <48 h of antibiotic therapy; therapy was started >48 h 
      after first positive culture; had complicated infections of endocarditis, bone 
      and joint infections, or central nervous system infections; Pitt bacteremia score 
      (PBS) ⩾ 4; or failed to respond to effective therapy necessitating continued 
      intravenous (IV) therapy. Patients were grouped by receipt of step-down oral 
      antibiotic therapy (PO group) versus continued IV therapy (IV group). Outcomes 
      included hospital length of stay (LOS), 30-day recurrence of BSI, 30-day 
      readmission, 30-day all-cause mortality, and catheter-related or drug-related 
      adverse events (AEs). RESULTS: Of 244 patients included, 40% received step-down 
      oral therapy (n = 98). Overall, the most common source of BSI was pneumonia 
      (22%), followed by skin and soft tissue infections (SSTI) (18%). Severity of 
      illness measured by intensive care unit (ICU) admission and PBS was similar. The 
      IV group had significantly longer LOS [median 10 (interquartile range 
      [IQR] = 5-21) versus 5 (4-6) days, p < 0.01] compared with the PO group. BSI 
      recurrence, readmission, all-cause mortality within 30 days, and AEs were similar 
      between the groups (p = ns). CONCLUSION: In uncomplicated streptococcal BSI, 
      patients treated with step-down oral antibiotic therapy had significantly shorter 
      LOS compared with continued IV therapy without compromise of clinical outcomes.
CI  - (c) The Author(s), 2022.
FAU - Kang, Amy
AU  - Kang A
AUID- ORCID: 0000-0003-3619-8904
AD  - Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, 
      CA, USA.
FAU - Beuttler, Richard
AU  - Beuttler R
AD  - Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, 
      CA, USA.
FAU - Minejima, Emi
AU  - Minejima E
AD  - Department of Clinical Pharmacy, School of Pharmacy, University of Southern 
      California, Los Angeles, CA, USA.
LA  - eng
PT  - Journal Article
DEP - 20220130
PL  - England
TA  - Ther Adv Infect Dis
JT  - Therapeutic advances in infectious disease
JID - 101606715
PMC - PMC8808041
OTO - NOTNLM
OT  - oral definitive therapy
OT  - oral step-down therapy
OT  - uncomplicated streptococcal bloodstream infections
COIS- Conflict of interest statement: The authors declared no potential conflicts of 
      interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2022/02/08 06:00
MHDA- 2022/02/08 06:01
PMCR- 2022/01/30
CRDT- 2022/02/07 05:32
PHST- 2021/05/17 00:00 [received]
PHST- 2021/12/21 00:00 [accepted]
PHST- 2022/02/07 05:32 [entrez]
PHST- 2022/02/08 06:00 [pubmed]
PHST- 2022/02/08 06:01 [medline]
PHST- 2022/01/30 00:00 [pmc-release]
AID - 10.1177_20499361211073248 [pii]
AID - 10.1177/20499361211073248 [doi]
PST - epublish
SO  - Ther Adv Infect Dis. 2022 Jan 30;9:20499361211073248. doi: 
      10.1177/20499361211073248. eCollection 2022 Jan-Dec.