Oral transition therapy versus intravenous therapy for the treatment of uncomplicated Enterococcal bloodstream infections.

purposeGrowing evidence supports oral transition therapy for gram-negative and certain Staphylococcus bloodstream infections (BSIs). However, clinical data remains limited for other organisms. The purpose of this study is to assess whether oral transition therapy is non-inferior to intravenous (IV)-only therapy for uncomplicated Enterococcal BSIs.

methodsThis single-center, retrospective, non-inferiority, observational study included adult patients with microbiology-confirmed Enterococcus bacteremia who received appropriate definitive antibiotic therapy. The primary composite outcome was treatment failure, defined as recurrence of BSI, development of deep-seated infection, or all-cause mortality within 90 days. Secondary outcomes included the individual components of the composite outcome, readmission within 90 days related to the index infection, hospital length of stay, and treatment-emergent adverse events.

resultsOf the 156 included patients, 123 received IV-only therapy, and 33 were transitioned to oral therapy. Treatment failure occurred in 18% (22/123) of patients in the IV-only group and 12% (4/33) in the oral group (RR 0.68, 95% CI 0.25-1.83), with a similar safety profile observed in both groups. Additionally, the hospital length of stay was significantly shorter in the oral group (6 vs. 8 days, p < 0.01).

conclusionGiven this study was underpowered, a statistical non-inferiority could not be established. However, given a numerically lower rate of treatment failure observed in the oral therapy group without any overt safety concern, oral transition therapy may be considered in clinically stable patients with uncomplicated Enterococcal BSIs.