Oral BEta-Lactam Stepdown to treat gram negative bacteremia in patienTs with obesitY (OBESITY)
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Publication Date
2025
Keywords
oregon, oaa 2025, psvmc
Disciplines
Gastroenterology | Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Abstract: Oral stepdown therapy for uncomplicated Gram-negative bloodstream infection is a widely accepted practice supported by randomized controlled and observational data. Fluoroquinolones, sulfamethoxazole-trimethoprim, and certain beta-lactams are frequently used for oral stepdown. Pharmacokinetic changes due to obesity may increase treatment failure, particularly with beta-lactams. However, current studies of oral stepdown for Enterobacterales bloodstream infections have not evaluated the impact of obesity on treatment failure. The purpose of this study was to assess whether patients with obesity (defined as BMI ≥ 30 kg/m2) receiving oral step-down therapy for Enterobacter-ales bacteremia have increased clinical treatment failure compared to nonobese patients. This was a multicenter retrospective study of adult patients hospitalized with monomicrobial Enterobacterales bloodstream infections between September 2021 to September 2024. Patients were excluded if they received > 4 days of IV therapy. Patient data were electronically extracted from the electronic health record. The primary outcome was clinical treatment failure, defined as a composite of 30-day recurrence, 30-day infection-related readmis-sion, and 30-day all-cause mortality. Secondary outcomes included duration of therapy and antibiotic selection. This study was reviewed by the institutional review board and deemed exempt. A total of 2,390 blood cultures were identified during the study period and 1,099 were included. An interim analysis was completed. Predominant pathogens included Escherichia coli (774/1,099, 70.4%) and Klebsiella pneumoniae (143/1,1099, 13%). A total of 221 (20.1%) patients met the composite primary outcome. Of the nonobese patients, 148 met the composite primary outcome of treatment failure (148/674, 21.9%) vs 73 patients with obesity (73/425, 17.2%). Overall, 17/1099 (1.5%) experienced recurrence, 135 (12.3%) patients readmitted, and 86/1099 (7.8%) patients expired. Further results and conclusions will be shared when the project is completed. Learning Objectives: Evaluate the association between treatment failure and obesity in adult patients receiving oral step-down therapy for Enterobacterales bacteremia. Presentation Category: Infectious Diseases
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Gastroenterology
Specialty/Research Institute
Pharmacy
