Prevalence, determinants and outcomes of intravenous to oral switch of antibiotic therapy in hospitalized adults with bloodstream infection: secondary analysis of a multicenter cohort

Abstract Background Intravenous to oral switch (IVOS) is considered safe in selected patients with bloodstream infection and provides operational advantages. Still, it is underused in many clinical settings. We evaluated IVOS patterns, associated factors and clinical outcomes in patients with bloodstream infection. Methods Secondary data from two prospective, multicenter cohort studies recruiting patients with bloodstream infection were analyzed. IVOS was assessed on day 3 and 7 after positive blood culture. Eligibility for IVOS was based on infectious focus, clinical safe switch criteria and antimicrobial susceptibility. Risk factors for non-IVOS were studied using multivariable logistic regression. Results Among 3824 patients, 2770 were included in secondary analysis, and 742 (19.4%) were eligible and evaluable for IVOS. By day 7, 240 patients (32.3%) underwent IVOS. Switch occurred on the day of discharge in 107 patients (44.6%), and one day before in 46 (19.2%). Most commonly used oral agents were ciprofloxacin (75 patients, 31.3%), sultamicillin (56, 23.3%), and cefuroxime axetil (27, 11.3%). Upon multivariable analysis, diabetes (OR=0.57 (0.38-0.88), p=0.010), chronic kidney disease (0.64 (0.41-0.99), p=0.048), Pitt bacteremia score ≥ 2 on day 3 (0.43 (0.19-0.97), p=0.042) and septic shock before day 7 (0.31 (0.11-0.87), p=0.027) were barriers to IVOS, while urogenital focus (2.22 (1.50-3.28), p<0.001) and two study centers were positively associated with IVOS. IVOS was associated with shorter length of stay (7 vs. 12 days, p<0.001) and lower 28-day mortality. Conclusions In clinically stable patients with bloodstream infection, IVOS was infrequently implemented. Barriers to IVOS should be addressed as part of antimicrobial stewardship programs.

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Journal
Open Forum Infectious Diseases
Published
2026-10-19
DOI
https://doi.org/10.1093/ofid/ofag666
Primary Topic
Antibiotics Pharmacokinetics and Efficacy
Type
article
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article

Prevalence, determinants and outcomes of intravenous to oral switch of antibiotic therapy in hospitalized adults with bloodstream infection: secondary analysis of a multicenter cohort

Elke Lemke, Gabriele Peyerl‐Hoffmann, Daniel Hornuß, Heike Spitznagel et al.
Open Forum Infectious Diseases
Antibiotics Pharmacokinetics and Efficacy
article

Prevalence, determinants and outcomes of intravenous to oral switch of antibiotic therapy in hospitalized adults with bloodstream infection: secondary analysis of a multicenter cohort

Elke Lemke, Gabriele Peyerl‐Hoffmann, Daniel Hornuß, Heike Spitznagel, Susanne Herold, Sarah Victoria Walker, Beryl Primrose Gladstone, Nadja Käding, Silke Peter, Evelina Tacconelli, David Tobys, Jörg Janne Vehreschild, K. Nagel, Georg Alexander Häcker, Christine Geffers, Kristina Schmauder, Siegbert Rieg, Norbert Thoma, Alexander Mischnik, Ariane Dinkelacker, Trinad Chakraborty, Benjamin Gebel, Jan Rupp, Maria J. G. T. Vehreschild, Larissa Künstle, Moritz Fritzenwanker, Winfried V. Kern, Harald Seifert, Evelyn Kramme, Can Imirzalioglu, Simone Eisenbeis, Elisabeth Stoll, Siri Göpel, Paul Higgins, Lea A Nikolai, Nicole Tewes, Lisa Höltig, Solvy Wolke, Sara Olawumi-Hutter, BLOOMY.COM study group, Annika Classen
article en

Abstract

Abstract Background Intravenous to oral switch (IVOS) is considered safe in selected patients with bloodstream infection and provides operational advantages. Still, it is underused in many clinical settings. We evaluated IVOS patterns, associated factors and clinical outcomes in patients with bloodstream infection. Methods Secondary data from two prospective, multicenter cohort studies recruiting patients with bloodstream infection were analyzed. IVOS was assessed on day 3 and 7 after positive blood culture. Eligibility for IVOS was based on infectious focus, clinical safe switch criteria and antimicrobial susceptibility. Risk factors for non-IVOS were studied using multivariable logistic regression. Results Among 3824 patients, 2770 were included in secondary analysis, and 742 (19.4%) were eligible and evaluable for IVOS. By day 7, 240 patients (32.3%) underwent IVOS. Switch occurred on the day of discharge in 107 patients (44.6%), and one day before in 46 (19.2%). Most commonly used oral agents were ciprofloxacin (75 patients, 31.3%), sultamicillin (56, 23.3%), and cefuroxime axetil (27, 11.3%). Upon multivariable analysis, diabetes (OR=0.57 (0.38-0.88), p=0.010), chronic kidney disease (0.64 (0.41-0.99), p=0.048), Pitt bacteremia score ≥ 2 on day 3 (0.43 (0.19-0.97), p=0.042) and septic shock before day 7 (0.31 (0.11-0.87), p=0.027) were barriers to IVOS, while urogenital focus (2.22 (1.50-3.28), p<0.001) and two study centers were positively associated with IVOS. IVOS was associated with shorter length of stay (7 vs. 12 days, p<0.001) and lower 28-day mortality. Conclusions In clinically stable patients with bloodstream infection, IVOS was infrequently implemented. Barriers to IVOS should be addressed as part of antimicrobial stewardship programs.

Open Forum Infectious Diseases
Goethe University Frankfurt (DE), University of Verona (IT), University of Freiburg (DE), University of Cologne (DE), Justus-Liebig-Universität Gießen (DE), University Medical Center Freiburg (DE), University Hospital Schleswig-Holstein (DE), German Center for Infection Research (DE), University Children's Hospital Tübingen (DE), University Hospital Frankfurt (DE), Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (DE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Institute of Medical Microbiology and Hygiene (DE), University Hospital Cologne (DE), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), University of Lübeck (DE)
Openalex Percentile: Top 14%
Antibiotics Pharmacokinetics and Efficacy
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