Early Transition to Oral Antibiotics Improves Gram-Negative Bacteremia Outcomes

A recent study conducted in Copenhagen, Denmark, found promise for gram-negative bacteremia which has seen a critical development in the optimization of the transition from intravenous (IV) to oral antibiotics within four days of the initial blood culture. The findings of the study were published in the Journal of American Medical Association.

The study utilized observational data from four hospitals in Copenhagen from January 1, 2018 yo December 31, 2021 and focused on adults with uncomplicated gram-negative bacteremia. The eligibility criteria included positive blood cultures, clinical stability within four days of the initial culture, availability of susceptibility reports on day 4 and the initiation of appropriate empirical IV antibiotic treatment within 24 hours of the blood culture.

Out of the 914 individuals included in the study, 47.4% transitioned early to the oral antibiotic treatment, while 52.6% received prolonged IV treatment. 90-day all-cause mortality was significantly lower in the early-switch group (6.9%) when compared to the group receiving prolonged IV treatment (14.3%).

The main outcome of the study found early transition to oral antibiotics within four days of the initial blood culture that showed a 90-day all-cause mortality risk comparable to that of continuing IV antibiotic treatment. The risk difference was -2.5% which indicating a lower risk in the early-switch group, despite not statistically significant. The analysis further solidified the findings observed, with a negligible risk difference of -0.1%.

This research utilized the target trial emulation framework that challenge the conventional wisdom in treating gram-negative bacteremia. The findings suggest that the timely transition to oral antibiotics could be an effective alternative to prolonged IV treatment that can promise improved patient outcomes and more efficient resource utilization.

Reference:

Tingsgård, S., Bastrup Israelsen, S., Jørgensen, H. L., Østergaard, C., & Benfield, T. (2024). Early switch from intravenous to oral antibiotics for patients with uncomplicated gram-negative bacteremia. JAMA Network Open, 7(1), e2352314. https://doi.org/10.1001/jamanetworkopen.2023.52314