Implementation of an early transition to oral antibiotics for patients with non-staphylococcal bacteremia via real-time stewardship intervention

Background Oral (PO) antibiotics are effective in treating uncomplicated bloodstream infections (BSIs), but they are underutilized. The objective of this study was to evaluate the impact of a standardized antimicrobial stewardship intervention for early transition to PO antibiotics 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 four-month period. Rates of PO transition and clinical outcomes were compared pre- and post-intervention. The primary outcome was rate of PO transition. Clinical failure (relapsed bacteremia, infection-attributable death, or new deep-seated infection with BSI organism) was a secondary outcome. Results A total of 187 and 177 BSIs were evaluated pre- and post-intervention, respectively. Overall, 44% (82/187) and 43% (76/177) met pre-specified criteria for PO transition; transition rates increased from 59% (48/82) pre-intervention to 93% (71/76) post-intervention (p<0.01). Baseline characteristics including severity of illness, underlying diseases and source of BSI were similar between groups. Clinical failure occurred in 7% (6/82) and 7% (5/76) of patients in the pre- and post-intervention groups at 90 days, respectively. Total mean antibiotic therapy duration was shorter in the post-intervention group (12.15 vs. 10.76 days; p=0.02). Secondary outcomes including length of stay, 30-day readmission, and antibiotic adverse events were similar between groups. Conclusion The implementation of a real-time antimicrobial stewardship intervention resulted in an increased rate of transition to PO antibiotics and fewer overall days of therapy without an observed difference in clinical or safety outcomes.