Reviewed by S. Shaefer Spires, MD, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC.
Wildenthal et al. evaluated patients with a history of injection drug use hospitalized in St. Louis, MO from January 2016 through December 2021 with complicated S. aureus bloodstream infections (including IE, epidural abscess, vertebral osteomyelitis, and septic arthritis). Patients who received oral antibiotics after an incomplete IV antibiotic course were significantly less likely to experience microbiologic failure, readmission, or death than patients discharged without oral antibiotics (P<.001). While both groups were still worse off than those who received the full standard of care parenteral regimen, there was no significant difference in microbiologic failure rates when comparing patients who were discharged on partial oral antibiotics after receiving at least 10 days of IV antibiotics with SOC regimens (P>.9).
There are multiple lessons to learn from this retrospective analysis: 1) When someone is leaving the hospital prior to finishing standard therapy, it appears offering PO antibiotics is a better option than nothing, 2) This study adds to the growing body of literature suggesting for those who have received at least 10 days of effective IV antibiotic therapy after clearance of bacteremia, a transition to oral antibiotics with outpatient support represents an effective treatment pathway.
https://doi.org/10.1093/cid/ciac714 Wildenthal JA, Atkinson A, Lewis S, et al. Outcomes of Partial Oral Antibiotic Treatment for Complicated Staphylococcus Aureus Bacteremia in People Who Inject Drugs. Clin Infect Dis. Published online September 2, 2022:ciac714.