Oral antibiotic stepdown therapy for uncomplicated streptococcal bloodstream infections

Objective: This study aimed to evaluate the role of oral antibiotic stepdown therapy in patients with uncomplicated streptococcal bacteremia. Streptococcus species are known pathogens in bloodstream infections (BSIs). Traditionally, BSIs were managed with intravenous (IV) antibiotics; however, growing literature supports oral antibiotics in invasive infections including BSIs. Design: This was a retrospective cohort study evaluating patients with streptococcal bacteremia between September 2019 and September 2021 at an academic safety-net hospital. Clinical outcomes were compared between patients completing treatment with IV antibiotics versus an oral stepdown regimen. The primary outcome, clinical failure, was a composite of BSI recurrence and infection-related readmission. Patients: Adult patients with at least one positive blood culture for any Streptococcus species were included. Patients with polymicrobial BSIs or complicated bacteremia were excluded. Results: 155 patients were included, 77 (49.7%) received a course of IV antibiotics and 78 (50.3%) received an oral antibiotic stepdown regimen. Clinical failure was not different between the IV and oral groups (15.6% vs. 15.4%, respectively; OR .99 [95% CI, .41 to 2.35]). No differences were observed in 30-day all-cause mortality. Patients that received oral antibiotics had a significantly shorter hospital length of stay by 6 days (6 vs 12 d, p < .01). Conclusions: Our results suggest that an oral stepdown regimen for uncomplicated streptococcal BSIs is associated with similar outcomes compared to IV antibiotics. Furthermore, oral antibiotics may offer reduced length of stay and avoidance of outpatient central line placement in patients with uncomplicated streptococcal BSIs.