Fluoroquinolone versus Beta-Lactam Oral Step-Down Therapy for Uncomplicated Streptococcal Bloodstream Infections

Authors

Kellie Arensman, Advocate Aurora Health
Maureen Shields, Advocate Aurora HealthFollow
Maya Beganovic, Advocate Aurora HealthFollow
Jessica Miller, Advocate Aurora HealthFollow
Erik LaChance, Advocate Aurora HealthFollow
Morgan Anderson, Advocate Aurora HealthFollow
Jennifer Dela-Pena, Advocate Aurora HealthFollow

Recommended Citation

Arensman K, Shields M, Beganovic M, et al. Fluoroquinolone versus Beta-Lactam Oral Step-Down Therapy for Uncomplicated Streptococcal Bloodstream Infections. Antimicrob Agents Chemother. 2020;64(11):e01515-20. Published 2020 Oct 20. doi:10.1128/AAC.01515-20.

Affiliations

Department of Pharmacy, Advocate Lutheran General Hospital

Russell Center for Research and Innovation

Department of Pharmacy, Advocate South Suburban Hospital

Department of Pharmacy, Advocate Trinity Hospital

Department of Pharmacy, Advocate Illinois Masonic Medical Center

Department of Pharmacy, Advocate Condell Medical Center

Department of Pharmacy, Advocate Good Shepherd Hospital

Abstract

Fluoroquinolones (FQs) are often preferred as oral step-down therapy for bloodstream infections (BSIs) due to favorable pharmacokinetic parameters; however, they are also associated with serious adverse events. The objective of this study was to compare clinical outcomes for patients who received an oral FQ versus an oral beta-lactam (BL) as step-down therapy for uncomplicated streptococcal BSIs. This multicenter, retrospective cohort study analyzed adult patients who completed therapy with an oral FQ or BL with at least one blood culture positive for a Streptococcus species from 1 January 2014 to 30 June 2019. The primary outcome was clinical success, defined as the lack of all-cause mortality, recurrent BSI with the same organism, and infection-related readmission at 90 days. A multivariable logistic regression model for predictors of clinical failure was conducted. A total of 220 patients were included, with 87 (40%) receiving an FQ and 133 (60%) receiving a BL. Step-down therapy with an oral BL was noninferior to an oral FQ (93.2% versus 92.0%; mean difference, 1.2%; 90% confidence interval [CI], -5.2 to 7.8). No differences were seen in 90-day mortality, 90-day recurrent BSI, 90-day infection-related readmission, or 90-day incidence of Clostridioides difficile-associated diarrhea. Predictors of clinical failure included oral step-down transition before day 3 (odds ratio [OR] = 5.18; 95% CI, 1.21, 22.16) and low-dose oral step-down therapy (OR = 2.74; 95% CI, 0.95, 7.90). Our results suggest that oral step-down therapy for uncomplicated streptococcal BSI with a BL is noninferior to an FQ.

Document Type

Article

PubMed ID

32839223