This study evaluates the effectiveness and safety of early transition to oral antibiotic therapy in stable E-BSI patients, confirms the therapeutic benefits of high-dose β-lactam antibiotics, and quantifies their significant advantages in carbon footprint reduction and medical cost savings, providing critical references for clinical practice and sustainable healthcare.
Literature Overview
This article, 'Very Early Transition to Oral Antibiotics in Uncomplicated Enterobacterales Bloodstream Infections: Effectiveness and Impact on Carbon Footprint Saving', published in the journal Antibiotics, reviews and summarizes the feasibility, effectiveness, and ecological benefits of early oral antibiotic transition strategies in stable patients with uncomplicated E-BSI. The study also compares the efficacy of different oral antibiotics and analyzes clinical/microbiological factors influencing transition decisions, offering data-driven support for optimizing clinical management.
Background Knowledge
Enterobacterales bloodstream infections (E-BSI) are clinically prevalent infections associated with high morbidity and mortality. Traditional treatment relies on intravenous (IV) antibiotics, but advancements in high-bioavailability oral antibiotics have made early transition strategies a growing research focus. Recent randomized controlled trials (RCTs) and observational studies support the non-inferiority of early oral transition, though debates persist regarding optimal transition timing and comparative efficacy of antibiotics. Additionally, the potential of oral therapy to reduce hospitalization duration, medical costs, and carbon emissions remains underquantified. Through retrospective cohort analysis, this study further explores the feasibility of very early oral transition in stable patients and evaluates its dual benefits for healthcare systems and the environment.
Research Methods and Experiments
The study employed a retrospective cohort design, enrolling 345 E-BSI patients treated at Hospital Universitari Mútua de Terrassa between 2021 and 2022. Participants were divided into an early oral transition group (EO group, n=163) and a non-early oral transition group (nEO group, n=182). Primary endpoints included 30-day mortality and recurrence rates; secondary endpoints encompassed length of hospitalization, treatment costs, and carbon emissions. The study compared efficacy differences between high-dose β-lactam antibiotics and quinolones or trimethoprim/sulfamethoxazole, and identified independent predictors of early oral transition through multivariable regression analysis.
Key Conclusions and Perspectives
Research Significance and Prospects
The findings advocate for very early oral transition strategies in stable, uncomplicated E-BSI patients, demonstrating their safety, efficacy, and dual benefits in reducing hospitalization burdens and carbon footprints. Future studies should clarify optimal transition windows, refine oral dosing regimens, and validate feasibility across diverse populations and multicenter settings.
Conclusion
This study provides the first systematic evaluation of very early oral antibiotic transition in uncomplicated Enterobacterales bloodstream infections, demonstrating that approximately half of patients can transition to oral therapy by day 3 without increased mortality or recurrence risks. Urinary tract infections independently promote oral transition, while high comorbidity indices, ESBL production, source control requirements, and delayed clinical stability hinder adoption. High-dose β-lactams exhibit comparable efficacy to quinolones or trimethoprim/sulfamethoxazole with no significant adverse events. Furthermore, early oral transition yields substantial reductions in hospitalization duration and carbon footprint, offering dual economic and environmental benefits. These findings inform clinical guidelines and provide novel insights for optimizing healthcare systems, particularly in antimicrobial stewardship and sustainable medical practices.
