Oral switch antibiotic therapy in uncomplicated Enterococcus faecalis bloodstream infection

Sarah Al Mansi; Margaret Pokalsky; Katherine Turnley; Andrew Freeman; P Brandon Bookstaver; Joseph Kohn; Hana R Winders; Sarah Withers; Majdi N Al-Hasan

doi:10.1093/jacamr/dlaf004

Oral switch antibiotic therapy in uncomplicated Enterococcus faecalis bloodstream infection

JAC Antimicrob Resist. 2025 Jan 23;7(1):dlaf004. doi: 10.1093/jacamr/dlaf004. eCollection 2025 Feb.

Authors

Sarah Al Mansi^{1

2}, Margaret Pokalsky¹, Katherine Turnley¹, Andrew Freeman¹, P Brandon Bookstaver^{3

4}, Joseph Kohn⁴, Hana R Winders⁴, Sarah Withers⁵, Majdi N Al-Hasan^{1

2}

Affiliations

¹ University of South Carolina School of Medicine, Columbia, SC 20203, USA.
² Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC, USA.
³ Department of Clinical Pharmacy and Outcomes Science, University of South Carolina College of Pharmacy, Columbia, SC, USA.
⁴ Department of Pharmacy, Prisma Health Midlands, Columbia, SC, USA.
⁵ Department of Pharmacy, Prisma Health Upstate, Greenville, SC, USA.

Abstract

Background: The role of oral switch antibiotic therapy in uncomplicated Enterococcus faecalis bloodstream infection (BSI) remains unclear. This retrospective cohort study examines the effectiveness of oral switch compared with standard intravenous antibiotic therapy in uncomplicated E. faecalis BSI.

Methods: Adults with first episodes of uncomplicated monomicrobial E. faecalis BSI were admitted to 10 Prisma Health hospitals in South Carolina from January 2021 to June 2023 were included. Deaths within 7 days were excluded to mitigate immortal time bias. Multivariate Cox proportional hazards regression examined the risk of treatment failure (all-cause mortality or recurrence) within 90 days after adjustment for the propensity of transitioning to oral switch therapy.

Results: Of 476 screened patients, 131 with uncomplicated E. faecalis BSI were included in the analysis. The median age was 70 years, 84 (64%) were men, and 46 (35%) had a urinary source of infection. Eighty-seven patients (66%) received standard intravenous therapy and 44 (34%) were transitioned to oral switch therapy. Aminopenicillins were the most commonly used antibiotics for oral switch therapy (33/44; 75%). There was no increased risk of treatment failure with oral switch therapy compared with standard intravenous therapy (hazard ratio 0.77, 95% CIs 0.23-2.57, P = 0.67). Hospital length of stay (HLOS) was 7 and 11 days in the oral switch and standard intravenous groups, respectively (P < 0.001).

Conclusions: Transitioning patients with uncomplicated E. faecalis BSI from intravenous to oral switch antibiotic therapy appears to be a promising strategy with shorter HLOS and no significant increase in the risk of treatment failure.