Comparison of Oral and Intravenous Definitive Antibiotic Therapy for Beta-Hemolytic Streptococcus Species Bloodstream Infections from Soft Tissue Sources: a Propensity Score-Matched Analysis

Yetmar, Zachary A.; Chesdachai, Supavit; Lahr, Brian D.; Challener, Douglas W.; Hannan, Kellie N. Arensman; Epps, Kevin; Stevens, Ryan W; Seville, Maria Teresa; Tande, Aaron J.; Virk, Abinash

doi:10.1128/aac.00120-23

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…It should be stated that not all previous studies were in support of partial oral antibiotic therapy for uncomplicated Streptococcus species BSIs. A recent investigation by Yetmar and colleagues examining 30-day mortality, relapse, or hospital readmission in BSIs due to beta-hemolytic Streptococcus species secondary to a soft tissue source of infection reached a different conclusion [ 21 ]. The study demonstrated higher treatment failure rates in patients transitioned to oral antibiotics after nearly 7 days of intravenous therapy as compared to propensity-matched patients who remained on intravenous antibiotics for the reminder of the treatment course.…”

Section: Discussionmentioning

confidence: 99%

“…Aminopenicillins and cephalosporins were by far the most commonly used oral antibiotics in this study. In a subgroup analysis, treatment failure rates were higher in patients who received low-dose as compared to high-dose oral antibiotics [ 21 ]. This latter finding was consistent with the results of a previous investigation by Arensman and colleagues [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our population, 77% of the viridans group streptococci and 99% of the S. pneumoniae were also susceptible to aminopenicillins. Based on the results of two previous studies, using high-dose oral aminopenicillins may be preferred [ 21 , 23 ]. The POET trial used amoxicillin 1000 mg four times a day for complicated streptococcal BSIs based on pharmacokinetic and pharmacodynamic parameters [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…It remains to be determined if this is the optimal amoxicillin dose in uncomplicated beta-hemolytic Streptococcus species BSIs. Although oral linezolid was not commonly used in the current or prior studies of streptococcal BSIs [ 15 , 16 , 17 , 21 , 23 ], it remains a viable option given its high bioavailability, prior clinical experience in respiratory and soft tissue sources of infections, and promising results in uncomplicated Staphylococcus aureus BSIs [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the short term, a meta-analysis combining the results of the current and previous studies of Streptococcus species BSIs may be useful [ 15 , 16 , 17 , 21 , 23 ]. This may overcome the small sample size, which is the biggest limitation of each study.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Broermann,

Al-Hasan,

Withers

et al. 2023

Microorganisms

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This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (−2.23 days, 95% CI −3.53, −0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Broermann,

Al-Hasan,

Withers

et al. 2023

Microorganisms

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Antibacterials

2024

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Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

Eleftheriotis,

Marangos,

Lagadinou

et al. 2023

Microorganisms

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Bacteremia and endocarditis are two clinical syndromes that, for decades, were managed exclusively with parenteral antimicrobials, irrespective of a given patient’s clinical condition, causative pathogen, or its antibiotic susceptibility profile. This clinical approach, however, was based on low-quality data and outdated expert opinions. When a patient’s condition has improved, gastrointestinal absorption is not compromised, and an oral antibiotic regimen reaching adequate serum concentrations is available, a switch to oral antibacterials can be applied. Although available evidence has reduced the timing of the oral switch in bacteremia to three days/until clinical improvement, there are only scarce data regarding less than 10-day intravenous antibiotic therapy in endocarditis. Many standard or studied oral antimicrobial dosages are smaller than the approved doses for parenteral administration, which is a risk factor for treatment failure; in addition, the gastrointestinal barrier may affect drug bioavailability, especially when the causative pathogen has a minimum inhibitory concentration that is close to the susceptibility breakpoint. A considerable number of patients infected by such near-breakpoint strains may not be potential candidates for oral step-down therapy to non-highly bioavailable antibiotics like beta-lactams; different breakpoints should be determined for this setting. This review will focus on summarizing findings about pathogen-specific tailoring of oral step-down therapy for bacteremia and endocarditis, but will also present laboratory and clinical data about antibiotics such as beta-lactams, linezolid, and fosfomycin that should be studied more in order to elucidate their role and optimal dosage in this context.

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Comparison of Oral and Intravenous Definitive Antibiotic Therapy for Beta-Hemolytic Streptococcus Species Bloodstream Infections from Soft Tissue Sources: a Propensity Score-Matched Analysis

Abstract: Beta-hemolytic streptococci are common causes of bloodstream infection (BSI). There is emerging data regarding oral antibiotics for BSI but limited for beta-hemolytic streptococcal BSI.

Cited by 4 publications

References 28 publications

Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Antibacterials

Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

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