番茄社区

Fewer than half of hospitalized patients with gram-negative bloodstream infections transitioned from intravenous to oral antibiotics by day 7, a retrospective cohort study showed.

In the cohort of over 4,500 patients, just 43% were transitioned from IV to oral antibiotics by day 7, but nearly 90% of patients were clinically stable and had source control within 5 days of receiving IV antibiotics, reported Anurag Malani, MD, of Trinity Health in Ann Arbor, Michigan, and colleagues in .

Notably, rates of transition by day 7 varied widely among the 24 hospitals included in the study, even though all of the hospitals had engaged in antimicrobial stewardship programs, Malani told 番茄社区. "To see a variation of 25.8% to 65.9% [in rates of transition] ... I think that's actually significant," he said.

"If you look at the broader care in the U.S. and not just these 24 hospitals, I'd be concerned that actually what's happening is even more staggering than this -- at places that may not have access to infectious diseases expertise or highly engaged antimicrobial stewardship programs," Malani explained.

Timely transition to oral antibiotics is critical because "prolonged treatment with IV antibiotics in the hospital or in the outpatient setting poses risks, such as phlebitis, venous thromboembolism, catheter occlusions, and catheter-related bloodstream infections, in addition to significant patient inconvenience and nursing workload," the authors wrote.

Malani pointed out that those patients in the study who stayed on IV antibiotics were more severely ill and had higher rates of comorbidities. "But the majority of patients in both groups were afebrile, clinically stable, and most of them had source control. So I think even in the parenteral group, there are probably opportunities for earlier oral transition," he said.

For this study, the researchers included 4,581 hospitalized patients with gram-negative bloodstream infections across 24 U.S. hospitals from January through December 2019. Median age was 67 years, and 52.2% were men.

The most common sources of infection among patients receiving oral antibiotics were the urinary tract (64.9%), hepatobiliary sources (12.1%), and intra-abdominal sources (9.9%).

Of those who stayed on IV therapy, 31.9% were immunosuppressed compared with 24.6% of patients who transitioned to oral antibiotics (P<0.001), and 39.5% required admission to the intensive care unit versus 17% (P<0.001). Patients who remained on IV antibiotics were also more likely to have fever or hypotension as of day 5 (16.2% vs 2.5%, P<0.001) or require kidney replacement therapy (10.7% vs 3.2%, P<0.001). They were also less likely to have source control within 7 days (70.9% vs 80.1%, P<0.001).

Median day of transition to oral antibiotics was day 5 (IQR 4-6 days). Total duration of antibiotic treatment was significantly shorter among the oral antibiotic group, with a median of 11 days (IQR 9-14 days) compared with 13 days in the IV group (IQR 8-16 days, P<0.001). The most commonly prescribed oral antibiotics were fluoroquinolones, β-lactams, and trimethoprim-sulfamethoxazole.

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