The Use of Step-Down Oral Antibiotic Therapy for Uncomplicated Gram-Negative Bacteremia and Risk Factors for Adverse Outcomes
Abstract
Background: Step-down oral antibiotic therapy (SDO) is commonly used to treat uncomplicated gram-negative bacteremia (GNB), but real-world treatment outcomes and risk factors for failure remain unclear.
Methods: We conducted a retrospective cohort study of hospitalized adults with uncomplicated GNB within a large integrated healthcare system from 2018 to 2022, stratifying patients by antibiotic route: complete course of intravenous antibiotic (CIV) or initial intravenous followed by SDO. The primary outcome was a composite of 90-day all-cause mortality, all-cause readmission, or recurrent GNB. Secondary analysis identified risk factors for adverse outcomes using multivariable Cox regression.
Results: We included 9164 patients, of whom 8263 received SDO and 901 received CIV therapy. All-cause mortality was 1.1% overall, with no significant difference between groups (CIV 1.4% vs SDO 1.0%, P = .3). All-cause readmission and recurrent GNB were more frequent in the CIV group than SDO group (33% vs 18%, and 5.8% vs 2.4%, respectively; both P < .001). A high Charlson Comorbidity Index (CCI) was independently associated with all adverse outcomes in the full cohort and in both treatment groups. Among SDO patients, fluoroquinolones were associated with a lower GNB recurrence rate (1.6%), whereas beta-lactams were linked to a higher recurrence rate (3.2%).
Conclusions: Step-down oral antibiotic therapy appears as effective as CIV for treating uncomplicated GNB, with comparable…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 9,164 participants or records.
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