Oral antibiotics safe, effective for transplant recipients with gram-negative bacteremia

January 18, 2024

2 min read

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Key takeaways:

• Patients given IV and oral antibiotics had similar rates of bacteremia recurrence and reinitiation of therapy.
• Patients who continued IV therapy were more likely to develop treatment associated complications.

Transitioning organ transplant recipients to oral antibiotic therapy for the treatment of uncomplicated gram-negative bacteremia is effective and associated with fewer adverse events compared with continued IV therapy, researchers found.

“There are fairly robust data in the immunocompetent population to suggest that treatment of uncomplicated gram-negative bacteremia with select oral antimicrobials is safe and effective. However, there are substantially less data in the immunocompromised and solid organ transplant population,” Eliezer Z. Nussbaum, MD, an infectious diseases physician at Tufts Medical Center, told Healio.

Transitioning solid organ transplant patients with uncomplicated gram-negative bacteremia was determined to be safe, effective and associated with fewer treatment related adverse events such as C. difficile infection compared with continued IV therapy. Image: Adobe Stock.

“Given the potential benefits of treatment with oral therapy that have been theorized or suggested in previous studies (shorter length of hospital stay, patient comfort, ease of administration, lack of IV catheter-associated complications), we wanted to systematically assess whether this practice was safe and effective in the solid organ transplant population. In addition, we wanted to assess and quantify other outcomes that may be associated with transition to oral therapy, including length of hospitalization,” Nussbaum said.

To do so, Nussbaum and colleagues identified all solid organ transplant recipients within the Massachusetts General and Brigham and Women’s Hospital systems between 2016 and 2021 with uncomplicated gram-negative bacteremia involving an organism susceptible to an oral antibiotic.

According to the study, the researchers compared outcomes of those transitioned to oral antibiotics with those who continued IV therapy for the duration of their treatment. The primary endpoints of the study were mortality, bacteremia recurrence and reinitiation of IV antibiotics, whereas secondary endpoints included length of stay, Clostridioides difficile infection and treatment-associated complications.

In total, 120 bacteremia events from 107 patients met were included in the oral group and 42 events from 40 patients were included in the IV group. Overall, the team determined there were no significant differences in mortality between the groups, or bacteremia recurrence and reinitiation of IV antibiotics.

They did find, however , that patients who transitioned to oral antibiotics had a shorter average length of stay by 1.97 days (95% CI, –0.39-3.56 days), whereas patients who continued IV treatment had 8.4 times higher odds of developing C. difficile (95% CI, 1.5-46.6) and 6.4 times higher odds of developing other treatment-associated complications (95% CI, 1.9-20.9).

“Our study suggests that transition to oral therapy for treatment of uncomplicated gram-negative bacteremia in solid organ transplant recipient is safe, effective and associated with fewer treatment related adverse effects compared with continued IV therapy,” Nussbaum said. “Ultimately, a prospective, randomized controlled trial would be useful to confirm these findings.”

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Sources/Disclosures

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Disclosures:
Nussbaum reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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