Effectiveness of oral step-down therapy and early oral switch for bloodstream infections caused by Enterobacterales: A post hoc emulation trial of the SIMPLIFY trial

Objectives: We investigated the effectiveness of early oral switch for treating Enterobacterales bloodstream infection (BSI) by performing a post hoc emulation trial of the SIMPLIFY trial. Methods: We conducted a post hoc analysis of a randomized controlled trial. We specified the target trial chara...

Descripción completa

Detalles Bibliográficos
Autores: Rando, E, Delgado-Valverde, M, Aguirre, JG, Carrión, LG, Vidal, MJB, Andrés, JLB, Rodríguez, MTP, Lamas, LM, de las Revillas, FA, Armiñanzas, C, de Alegría-Puig, CR, Aguilar, PJ, Martínez-Rubio, MD, Sáez-Béjar, C, de las Cuevas, C, Martín-Aspas, A, Galán, F, Yuste, JR, Leiva-León, J, Bou, G, González, PC, Boix-Palop, L, Xercavins-Valls, M, Goenaga-Sánchez, MA, Anza, DV, Castón, JJ, Rufián, MR, Merino, E, Rodríguez, JC, Loeches, B, Rosso-Fernández, C, Bravo-Ferrer, JM, Retamar-Gentil, P, Rodríguez-Baño, J, Cortés, LEL
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:dnet:isabial_____::4c7088a78195d1f377dd78527fb44669
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones12528
https://www.sciencedirect.com/science/article/pii/S1201971225001407?pes=vor&utm_source=clarivate&getft_integrator=clarivate
Access Level:acceso abierto
Palabra clave:Antimicrobial stewardship
Oral switch
Enterobacterales
Bloodstream infection
Descripción
Sumario:Objectives: We investigated the effectiveness of early oral switch for treating Enterobacterales bloodstream infection (BSI) by performing a post hoc emulation trial of the SIMPLIFY trial. Methods: We conducted a post hoc analysis of a randomized controlled trial. We specified the target trial characteristics selecting patients who achieved clinical stability on day 5. We categorized patients into those who switched on day 5 and those who continued intravenously. The primary outcome was clinical cure at the test of cure. We set a propensity score for being switched on day 5 to reduce confounding. We ran simple, not-propensity-adjusted, and propensity-adjusted logistic regression models to ascertain the association of switch on day 5 with clinical cure. Results: Among 303 patients who achieved clinical stability on day 5, 110 (36.3%) were switched orally on day 5, and 193 (63.7%) were kept intravenously. We detected no difference in clinical cure between those switched on day 5 and those continued intravenously (risk ratios 1.04, 95% confidence intervals [CI] 0.98-1.10). Propensity-adjusted analysis did not show an association between day 5 switch and clinical cure (OR 2.10, 95% CI 0.96-7.41). Conclusion: Oral step-down therapy on day 5 was not associated with worse clinical cure for Enterobacterales BSI. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Similares en LA Referencia