Outcomes in uncomplicated β-hemolytic Streptococcal bloodstream infections transitioned from IV to oral antimicrobial therapy

Abstract

Objective: To evaluate clinical outcomes in patients with uncomplicated β-hemolytic Streptococcus spp. bloodstream infections (BSI) transitioned to oral antimicrobial therapy (OAT) compared with those that remain on intravenous antimicrobial therapy. Design: Retrospective cohort study. Setting: Tertiary academic hospital. Methods: This retrospective cohort study included adult patients hospitalized between 1/1/2013 and 12/31/2019 diagnosed with uBSI due to β-hemolytic streptococci. Patients were excluded if BSI was due to endovascular, central nervous system, or bone/joint infection or patient was immunosuppressed or died within 72 hours of identification of BSI. We compared outcomes including: 30-day mortality, antimicrobial therapy, BSI relapse, 30-day rehospitalization, adverse drug events, and reversion to IV therapy. Fisher’s exact test was used for categorical variables; Mann – Whitney test and Independent T-test for continuous variables. Results: 232 BSIs were included. OAT was used in 152 (65%). Cohort demographics were similar. Mortality was also similar between cohorts (2% vs 6% P = .13). Hospital length of stay was shorter in the OAT cohort with a median of 5 days (interquartile range 4.00, 8.00) versus 8 (5.00, 16.00) in the IV group (P < .0001). Patients transitioned to OAT were more likely to finish antibiotics outpatient (93% vs 62% P < .001). Conclusion: For β-hemolytic Streptococcus uBSI, OAT was associated with decreased length of stay without adverse clinical outcomes. Opportunities exist to modify clinical management of uBSI.