Oral antibiotic stepdown therapy for uncomplicated streptococcal bloodstream infections.

Objective: This study aimed to evaluate the role of oral antibiotic stepdown therapy in patients with uncomplicated streptococcal bacteremia. Design: This was a retrospective cohort study evaluating patients with streptococcal bacteremia between September 2019 and September 2021 at an academic safety-net hospital. Clinical outcomes were compared between patients completing treatment with IV antibiotics versus an oral stepdown regimen. The primary outcome, clinical failure, was a composite of BSI recurrence and infection-related readmission. Patients: Adult patients with at least one positive blood culture for any Results: 155 patients were included, 77 (49.7%) received a course of IV antibiotics and 78 (50.3%) received an oral antibiotic stepdown regimen. Clinical failure was not different between the IV and oral groups (15.6% vs. 15.4%, respectively; OR .99 [95% CI, .41 to 2.35]). No differences were observed in 30-day all-cause mortality. Patients that received oral antibiotics had a significantly shorter hospital length of stay by 6 days (6 vs 12 d, Conclusions: Our results suggest that an oral stepdown regimen for uncomplicated streptococcal BSIs is associated with similar outcomes compared to IV antibiotics. Furthermore, oral antibiotics may offer reduced length of stay and avoidance of outpatient central line placement in patients with uncomplicated streptococcal BSIs.