TOPLINE:

In patients with uncomplicated nonstaphylococcal bloodstream infections (BSIs), implementation of a real-time stewardship intervention increased the rate of transition from intravenous (IV) to oral antibiotics, with no meaningful differences in clinical or safety outcomes.

METHODOLOGY:

• Researchers conducted a quasi-experimental study to evaluate whether a standardized antimicrobial stewardship intervention increases the rate of early transition from IV to oral antibiotic therapy for patients with uncomplicated nonstaphylococcal BSIs.
• They compared 82 patients in a preintervention retrospective cohort (median age, 68 years; 61% men) with 76 patients in a prospectively evaluated cohort that received a real-time stewardship intervention (median age, 62 years; 55% men).
• A stewardship team monitored daily real‑time electronic alerts from gram stain and rapid molecular testing to identify BSIs caused by Enterobacterales, Streptococcus species, and Enterococcus faecalis and subsequently recommended preferred oral antibiotic regimens to the primary team.
• The preintervention cohort received standard of care, without specific real-time guidance for early transition to oral antibiotics.
• The primary outcome was the rate of transition to oral antibiotics; secondary outcomes included the composite of clinical failure within 30 and 90 days of a positive blood culture (relapsed bacteremia, infection-attributable death, or new deep-seated infection) and safety measures.

TAKEAWAY:

• The percentage of patients who transitioned to oral antibiotics increased from 59% in the preintervention cohort to 93% in the postintervention cohort (P < .01).
• At day 90, clinical failure occurred in 7% of patients in each cohort, and 30‑day mortality did not differ significantly between the cohorts.
• The mean total duration of antibiotic therapy was shorter in the postintervention vs preintervention cohort (10.76 vs 12.15 days; P = .02); the median duration of IV therapy also decreased from 6.4 days in the preintervention cohort to 3.9 days in the postintervention cohort (P < .01).
• The length of hospital stay and rates of discharge to home, antibiotic adverse events, Clostridioides difficile infection, and 30-day readmission did not differ significantly between the cohorts.

IN PRACTICE:

“This study demonstrates that a real-time stewardship-driven intervention can significantly increase the rate of PO [oral] transition without compromising clinical or safety outcomes,” the authors wrote.

“As such, targeted stewardship interventions have the potential to improve quality of care, reduce healthcare utilization, and support broader adoption of evidence-based practices for the management of BSIs,” they added.

SOURCE:

The study was led by Tyler Tate, MD, University of Pittsburgh School of Medicine, Pittsburgh. It was published online on March 4, 2026, as a brief report in Open Forum Infectious Diseases.

LIMITATIONS:

The study was not powered to definitively assess the clinical efficacy of oral vs IV therapy. Data on specific dosing regimens for individual patients were not collected. Moreover, the study was conducted at a single center with a robust antimicrobial stewardship program, possibly limiting applicability to settings with fewer resources. 

DISCLOSURES:

No funding source was explicitly reported for the study. Some authors disclosed receiving investigator‑initiated funding from pharmaceutical companies or serving as advisors or consultants or participating on speakers bureaus for multiple companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.