ArticleJournal of Yeungnam medical science2026
Safety and efficacy of early oral switch in Enterobacterales bacteremia: a systematic review and meta-analysis.
Article in Journal of Yeungnam medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly oral switch (EOS) has been proposed as an alternative to prolonged intravenous (IV) therapy for Enterobacterales bacteremia; however, its safety and effectiveness have not been clearly established. This systematic review and meta-analysis evaluated whether EOS reduces treatment failure in uncomplicated Enterobacterales bacteremia and examined how the timing of switching affects outcomes.
methodsWe conducted a systematic review and random-effects meta-analysis of randomized controlled trials and observational studies that compared EOS with continued IV therapy in adults with uncomplicated Enterobacterales bacteremia. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. The primary outcome was treatment failure by ≤90 days. Prespecified analyses evaluated the timing of the switch.
resultsAcross 10 studies that met the inclusion criteria, EOS was associated with lower treatment failure than continued IV therapy (RR, 0.72; 95% CI, 0.58-0.89; I²=26%). Switching within 4 days reduced the failure (RR, 0.58; 95% CI, 0.44-0.76; I²=0%), whereas switching after 4 days showed no clear advantage (RR, 0.87; 95% CI, 0.71-1.06; I²=0%). No evidence of small study effects was observed.
conclusionEOS was associated with a lower risk of treatment failure than prolonged IV therapy, with the greatest benefit observed when the switch occurred within 4 days. These findings should be interpreted with clinical caution given that most of the evidence is observational.
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