Implementation of an Early Transition to Oral Antibiotics for Patients With Nonstaphylococcal Bacteremia via Real-Time Stewardship Intervention

Abstract Background 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. Methods 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. Results 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. Conclusions 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.