Variability in oral antibiotic step-down therapy in the management of Gram-negative bloodstream infections

•Among ID providers, there is wide variety in oral step down practices in Gram-negative bloodstream infection (GN-BSI).•Many ID providers (40%) practice oral step-down for some sources of GN-BSI but not others.•ID providers in the USA are more likely to practice oral step-down that those outside the...

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Vydáno v:International Journal of Antimicrobial Agents Ročník 58; číslo 6; s. 106451
Hlavní autoři: Thaden, Joshua T., Tamma, Pranita D., Doi, Yohei, Daneman, Nick
Médium: Journal Article
Jazyk:angličtina
Vydáno: Netherlands Elsevier Ltd 01.12.2021
Elsevier BV
Témata:
Administration, Intravenous
Administration, Oral
Anti-Bacterial Agents
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
antibiotics
Bacteraemia
Bacteremia
Bacteremia - drug therapy
Bacteremia - microbiology
blood flow
Bloodstream infection
Cross Infection
Cross Infection - drug therapy
Gram-negative
Gram-Negative Bacterial Infections
Gram-Negative Bacterial Infections - drug therapy
Humans
Infectious Disease
intravenous injection
Oral step-down
pneumonia
Practice Patterns, Physicians
Practice Patterns, Physicians' - statistics & numerical data
surveys
Surveys and Questionnaires
Bacteraemia
Bloodstream infection
Gram-negative
Oral step-down
ISSN:0924-8579, 1872-7913, 1872-7913
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Shrnutí:•Among ID providers, there is wide variety in oral step down practices in Gram-negative bloodstream infection (GN-BSI).•Many ID providers (40%) practice oral step-down for some sources of GN-BSI but not others.•ID providers in the USA are more likely to practice oral step-down that those outside the USA (OR = 4.35; P < 0.001).•Most ID providers (76%) were willing to enrol patients in a RCT of early oral step-down versus full IV therapy for GN-BSI. There are important gaps in the literature regarding the role and timing of oral therapy for Gram-negative bloodstream infections (GN-BSIs). To better understand contemporary management practices involving oral step-down in GN-BSI, we conducted an international survey of infectious diseases (ID) specialists. We developed and disseminated an online survey to ID specialists to assess practice patterns involving oral step-down in GN-BSIs, including providers from six continents and 28 countries. χ2 tests and generalised estimating equations were used to identify factors associated with oral step-down. In total, 277 ID specialists completed the survey (64% physicians, 31% pharmacists). Relative to a line source, oral step-down was more common in abdominal [OR = 1.96 (95% CI 1.48–2.61); P < 0.001], pneumonia [2.24 (1.67–2.99); P < 0.001], skin [7.26 (4.71–11.20); P < 0.001] and urinary [9.15 (5.73–14.60); P < 0.001] sources of GN-BSI. US providers were more likely to practice oral step-down than non-US providers (OR = 4.35, 95% CI 2.57–7.36; P < 0.001). Moreover, 40% of providers practice oral step-down for some, but not all, sources of GN-BSI. Among all providers, 23–53% (depending on GN-BSI source) recommend extended (≥5 days) intravenous (IV) therapy before oral step-down or ongoing IV therapy. Most respondents (76% of all providers; 80% of ID physicians) expressed interest in enrolling patients in a trial of full IV versus early oral step-down for GN-BSI. There is extensive heterogeneity in oral step-down practices for GN-BSI. The optimal role of oral step-down in managing GN-BSIs warrants further investigation.
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content type line 23
ISSN:0924-8579
1872-7913
1872-7913
DOI:10.1016/j.ijantimicag.2021.106451