Sarah A Nisly1, Dominique L McClain2, Amy G Fillius2, Kyle A Davis3. 1. School of Pharmacy, Wingate University, 515 N. Main St., Wingate, NC 28174, USA; School of Pharmacy Alumna, Wingate University, 515 N. Main St., Wingate, NC 28174, USA. Electronic address: s.nisly@wingate.edu. 2. School of Pharmacy Alumna, Wingate University, 515 N. Main St., Wingate, NC 28174, USA. 3. Internal Medicine, Department of Pharmacy, Wake Forest Baptist Medical Center, 1 Medical Center Blvd., Winston Salem, NC 27157, USA.
Abstract
OBJECTIVES: Treatment of bacteraemia with oral antibiotics has the potential to reduce hospital length of stay, treatment costs and line-related complications. To date, small trials have supported the use of specific classes of antibiotics, primarily fluoroquinolones (FQs), in the treatment of Gram-negative bloodstream infections (GNBSIs). Currently, limited data exist evaluating treatment with β-lactams (BLs) or trimethoprim/sulfamethoxazole (SXT). The purpose of this study was to compare treatment of GNBSIs across three different oral antibiotic classes. METHODS: A retrospective cohort of hospitalised patients with GNBSI receiving initial intravenous (i.v.) antibiotic therapy followed by step-down oral therapy was conducted. Patients were divided into one of three oral antibiotic treatment groups: FQ; BL; or SXT. The composite primary endpoint was treatment failure, including 30-day mortality, recurrent bacteraemia or transition back to i.v. antibiotics. Additional endpoints included secondary infections and individual components within the primary endpoint. Categorical endpoints were analysed using χ2 test or Fisher's exact test, whilst continuous variables were assessed by one-way ANOVA. RESULTS: A total of 204 patients were included in the analysis. The majority of patients received a FQ (136; 66.7%), followed by a BL (46; 22.5%) and SXT (22; 10.8%). Treatment failure occurred in 15 patients (7.4%), with no statistically significant differences between groups. Likewise, individual composite outcomes and secondary outcomes demonstrated no statistically significant differences. CONCLUSION: Transitioning to oral antibiotics to complete GNBSI treatment can offer many advantages. As FQ resistance increases, data supporting the use of a BL or SXT in GNBSI treatment will become essential.
OBJECTIVES: Treatment of bacteraemia with oral antibiotics has the potential to reduce hospital length of stay, treatment costs and line-related complications. To date, small trials have supported the use of specific classes of antibiotics, primarily fluoroquinolones (FQs), in the treatment of Gram-negative bloodstream infections (GNBSIs). Currently, limited data exist evaluating treatment with β-lactams (BLs) or trimethoprim/sulfamethoxazole (SXT). The purpose of this study was to compare treatment of GNBSIs across three different oral antibiotic classes. METHODS: A retrospective cohort of hospitalised patients with GNBSI receiving initial intravenous (i.v.) antibiotic therapy followed by step-down oral therapy was conducted. Patients were divided into one of three oral antibiotic treatment groups: FQ; BL; or SXT. The composite primary endpoint was treatment failure, including 30-day mortality, recurrent bacteraemia or transition back to i.v. antibiotics. Additional endpoints included secondary infections and individual components within the primary endpoint. Categorical endpoints were analysed using χ2 test or Fisher's exact test, whilst continuous variables were assessed by one-way ANOVA. RESULTS: A total of 204 patients were included in the analysis. The majority of patients received a FQ (136; 66.7%), followed by a BL (46; 22.5%) and SXT (22; 10.8%). Treatment failure occurred in 15 patients (7.4%), with no statistically significant differences between groups. Likewise, individual composite outcomes and secondary outcomes demonstrated no statistically significant differences. CONCLUSION: Transitioning to oral antibiotics to complete GNBSI treatment can offer many advantages. As FQ resistance increases, data supporting the use of a BL or SXT in GNBSI treatment will become essential.