Variability in oral antibiotic step-down therapy in the management of Gram-negative bloodstream infections

ABSTRACT Objectives There are important gaps in the literature regarding the role and timing of oral therapy for treatment of gram-negative bloodstream infections (GN-BSI). To better understand contemporary management practices involving oral step-down in GN-BSI, we conducted an international survey of infectious diseases (ID) specialists. Methods We developed and disseminated an online survey to ID specialists to assess practice patterns involving oral step-down in GN-BSI, including providers from six continents and 28 countries. Chi square tests and generalized estimating equations were used to identify factors associated with oral step-down. Results In total, 277 ID specialists completed the survey (64% physicians, 31% pharmacists). Relative to a line source, oral step-down was more common in abdominal (odds ratio [OR] 1.96; 95% CI 1.48-2.61; p Conclusions There is extensive heterogeneity in oral step-down practices for GN-BSI. The optimal role of oral step-down in managing GN-BSI is ripe for further investigation.