{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T20:42:17Z","timestamp":1791751337592,"version":"4.3.4"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We assessed the safety and efficacy of oral antibiotic step-down therapy for uncomplicated gram-negative blood stream infections in solid-organ transplant recipients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We identified all solid-organ transplant recipients within the Massachusetts General and Brigham and Women's Hospital systems from 2016 to 2021 with uncomplicated gram-negative bacteremia involving an organism susceptible to an acceptably bioavailable oral antibiotic agent. Using inverse probability of treatment-weighted models based on propensity scores adjusting for potential clinical confounders, we compared outcomes of those transitioned to oral antibiotics with those who continued intravenous (IV) therapy for the duration of treatment. Primary endpoints were mortality, bacteremia recurrence, and reinitiation of IV antibiotics. Secondary endpoints included length of stay, Clostridioides difficile infection, treatment-associated complications, and tunneled central venous catheter placement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 120 bacteremia events from 107 patients met inclusion criteria in the oral group and 42 events from 40 patients in the IV group. There were no significant differences in mortality, bacteremia recurrence, or reinitiation of IV antibiotics between groups. Patients transitioned to oral antibiotics had an average length of stay that was 1.97 days shorter (95% confidence interval [CI], \u2212.39 to 3.56 days; P = .005). Odds of developing C. difficile and other treatment-associated complications were 8.4 times higher (95% CI, 1.5\u201346.6; P = .015) and 6.4 times higher (95% CI, 1.9\u201320.9; P = .002), respectively, in the IV group. Fifty-five percent of patients in the IV group required tunneled catheter placement. There was no difference in treatment duration between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Oral step-down therapy was effective and associated with fewer treatment-related adverse events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae007","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T01:03:15Z","timestamp":1704848595000},"page":"208-214","source":"Crossref","is-referenced-by-count":18,"title":["Oral Antibiotics for Treatment of Gram-Negative Bacteremia in Solid Organ Transplant Recipients: A Propensity Score Weighted Retrospective Observational Study"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6900-968X","authenticated-orcid":false,"given":"Eliezer Zachary","family":"Nussbaum","sequence":"first","affiliation":[{"name":"Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Koo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women's Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-2234","authenticated-orcid":false,"given":"Camille N","family":"Kotton","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Massachusetts General Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"2024071918114537500_ciae007-B1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.amjmed.2021.10.007","article-title":"Oral is the new IV. Challenging decades of blood and bone infection dogma: a systematic review","volume":"135","author":"Wald-Dickler","year":"2022","journal-title":"Am J Med"},{"key":"2024071918114537500_ciae007-B2","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1080\/0036554021000026933","article-title":"Linezolid versus ceftriaxone\/cefpodoxime in patients hospitalized for the treatment of Streptococcus pneumoniae pneumonia","volume":"34","author":"San Pedro","year":"2002","journal-title":"Scand J Infect Dis"},{"key":"2024071918114537500_ciae007-B3","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1086\/424506","article-title":"A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection","volume":"39","author":"Schrenzel","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2024071918114537500_ciae007-B4","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/jac\/dkh088","article-title":"Linezolid compared with teicoplanin for the treatment of suspected or proven Gram-positive infections","volume":"53","author":"Wilcox","year":"2004","journal-title":"J Antimicrob Chemother"},{"key":"2024071918114537500_ciae007-B5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1086\/595686","article-title":"Complicated skin and skin structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study","volume":"48","author":"Wilcox","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2024071918114537500_ciae007-B6","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1177\/106002809603000605","article-title":"Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis","volume":"30","author":"Amodio-Groton","year":"1996","journal-title":"Ann Pharmacother"},{"key":"2024071918114537500_ciae007-B7","doi-asserted-by":"crossref","first-page":"e843-9","DOI":"10.1016\/j.ijid.2012.07.009","article-title":"A prospective, randomized, double dummy, placebo-controlled trial of oral cefditoren pivoxil 400 mg once daily as switch therapy after intravenous ceftriaxone in the treatment of acute pyelonephritis","volume":"16","author":"Monmaturapoj","year":"2012","journal-title":"Int J Infect Dis"},{"key":"2024071918114537500_ciae007-B8","doi-asserted-by":"crossref","first-page":"2790","DOI":"10.1007\/s10620-014-3233-0","article-title":"Early oral antibiotic switch compared with conventional intravenous antibiotic therapy for acute cholangitis with bacteremia","volume":"59","author":"Park","year":"2014","journal-title":"Dig Dis Sci"},{"key":"2024071918114537500_ciae007-B9","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1001\/jamainternmed.2018.6226","article-title":"Association of 30-day mortality with oral step-down vs continued intravenous therapy in patients hospitalized with Enterobacteriaceae bacteremia","volume":"179","author":"Tamma","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2024071918114537500_ciae007-B10","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1002\/phar.2024","article-title":"Intravenous-only or intravenous transitioned to oral antimicrobials for Enterobacteriaceae-associated bacteremic urinary tract infection","volume":"37","author":"Rieger","year":"2017","journal-title":"Pharmacotherapy"},{"key":"2024071918114537500_ciae007-B11","doi-asserted-by":"crossref","first-page":"e2020166","DOI":"10.1001\/jamanetworkopen.2020.20166","article-title":"Oral \u03b2-lactam antibiotics vs fluoroquinolones or trimethoprim-sulfamethoxazole for definitive treatment of Enterobacterales bacteremia from a urine source","volume":"3","author":"Sutton","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2024071918114537500_ciae007-B12","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/phar.2099","article-title":"Antimicrobial agents and catheter complications in outpatient parenteral antimicrobial therapy","volume":"38","author":"Keller","year":"2018","journal-title":"Pharmacotherapy"},{"key":"2024071918114537500_ciae007-B13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/cid\/cix733","article-title":"Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy","volume":"66","author":"Keller","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2024071918114537500_ciae007-B14","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1186\/s12879-020-05498-2","article-title":"Oral beta-lactam step down in bacteremic E. coli urinary tract infections","volume":"20","author":"Saad","year":"2020","journal-title":"BMC Infect Dis"},{"key":"2024071918114537500_ciae007-B15","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jgar.2019.07.026","article-title":"Oral antibiotics for the treatment of Gram-negative bloodstream infections: a retrospective comparison of three antibiotic classes","volume":"20","author":"Nisly","year":"2020","journal-title":"J Glob Antimicrob Resist"},{"key":"2024071918114537500_ciae007-B16","doi-asserted-by":"crossref","first-page":"100544","DOI":"10.1016\/j.trre.2020.100544","article-title":"Vascular access in kidney transplant recipients","volume":"34","author":"Karim","year":"2020","journal-title":"Transplant Rev (Orlando)"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciae007\/56346815\/ciae007.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/79\/1\/208\/58599954\/ciae007.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/79\/1\/208\/58599954\/ciae007.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T18:13:06Z","timestamp":1721412786000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/79\/1\/208\/7513381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,9]]},"published-print":{"date-parts":[[2024,7,19]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciae007","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,7,15]]},"published":{"date-parts":[[2024,1,9]]}}}