Prevalence, determinants and outcomes of intravenous to oral switch of antibiotic therapy in hospitalized adults with bloodstream infection: secondary analysis of a multicenter cohort
Year: 2026
Type: article
Abstract: Background Intravenous to oral switch (IVOS) is considered safe in selected patients with bloodstream infection and provides operational advantages. Still, it is underused in many clinical settings. We evaluated IVOS patterns, associated factors and clinical outcomes in patients with bloodstream infection. Methods Secondary data from two prospective, multicenter cohort studies recruiting patients with bloodstream infection were analyzed. IVOS was assessed on day 3 and 7 after positive blood culture. Eligibility for IVOS was based on infectious focus, clinical safe switch criteria and antimicrobial susceptibility. Risk factors for non-IVOS were studied using multivariable logistic regression. Results Among 3824 patients, 2770 were included in secondary analysis, and 742 (19.4%) were eligible and evaluable for IVOS. By day 7, 240 patients (32.3%) underwent IVOS. Switch occurred on the day of discharge in 107 patients (44.6%), and one day before in 46 (19.2%). Most commonly used oral agents were ciprofloxacin (75 patients, 31.3%), sultamicillin (56, 23.3%), and cefuroxime axetil (27, 11.3%). Upon multivariable analysis, diabetes (OR=0.57 (0.38-0.88), p=0.010), chronic kidney disease (0.64 (0.41-0.99), p=0.048), Pitt bacteremia score ≥ 2 on day 3 (0.43 (0.19-0.97), p=0.042) and septic shock before day 7 (0.31 (0.11-0.87), p=0.027) were barriers to IVOS, while urogenital focus (2.22 (1.50-3.28), p<0.001) and two study centers were positively associated with IVOS. IVOS was associated with shorter length of stay (7 vs. 12 days, p<0.001) and lower 28-day mortality. Conclusions In clinically stable patients with bloodstream infection, IVOS was infrequently implemented. Barriers to IVOS should be addressed as part of antimicrobial stewardship programs.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofag666
Authors: Lea A Nikolai, Beryl P Gladstone, Sarah V Walker, Jörg J Vehreschild, Kristina Schmauder, Simone Eisenbeis, Alexander Mischnik, Evelyn Kramme, Christine Geffers, Siegbert Rieg, Trinad Chakraborty, Maria J G T Vehreschild, Harald Seifert, Jan Rupp, Silke Peter, Winfried V Kern, Evelina Tacconelli, Daniel Hornuss, Siri Göpel, BLOOMY.COM study group, Elke Lemke, Norbert Thoma, Solvy Wolke, Can Imirzalioglu, Susanne Herold, Nicole Tewes, Moritz Fritzenwanker, Annika Classen, David Tobys, Paul Higgins, Nadja Käding, Benjamin Gebel, Lisa Höltig, Katharina Nagel, Larissa Künstle, Elisabeth Stoll, Ariane Dinkelacker, Gabriele Peyerl-Hoffmann, Georg Häcker, Heike Spitznagel, Sara Olawumi-Hutter
Institutions: University Children's Hospital Tübingen, University of Tübingen, German Center for Infection Research, University of Cologne, University Hospital Cologne, Goethe University Frankfurt, Institute of Medical Microbiology and Hygiene, University of Freiburg, University Medical Center Freiburg, University Hospital Schleswig-Holstein, University of Lübeck, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, Justus-Liebig-Universität Gießen, University Hospital Frankfurt, Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Verona
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W7222888089
FWCI:
Cites:
Cited by:
Related to: