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

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2026
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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.
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Authors Lea A Nikolai, Beryl Primrose Gladstone, Sarah Victoria Walker, Jörg Janne Vehreschild, Kristina Schmauder, Simone Eisenbeis, Alexander Mischnik, Evelyn Kramme, Christine Geffers, Siegbert Rieg, Trinad Chakraborty, Maria J. G. T. Vehreschild, Harald Seifert, Jan Rupp, Silke Peter, Winfried V. Kern, Evelina Tacconelli, Daniel Hornuß, Siri Göpel, BLOOMY.COM study group, Elke Lemke, Norbert Thoma, Solvy Wolke, Can Imirzalioglu, Susanne Herold, Nicole Tewes, Moritz Fritzenwanker, Annika Classen, David Tobys, Paul Higgins, Nadja Käding, Benjamin Gebel, Lisa Höltig, K. Nagel, Larissa Künstle, Elisabeth Stoll, Ariane Dinkelacker, Gabriele Peyerl‐Hoffmann, Georg Alexander Häcker, Heike Spitznagel, Sara Olawumi-Hutter
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag666
URL
https://doi.org/10.1093/ofid/ofag666
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