Oral switch therapy for paediatric Staphylococcus aureus bloodstream infections: A retrospective study in a tertiary hospital.

OBJECTIVES

Prolonged intravenous (IV) antibiotic therapy remains standard for Staphylococcus aureus bloodstream infections (SAB). However, early oral switch may offer a safe alternative. We evaluated the oral switch strategy in children with SAB.

METHODS

All pediatric SAB cases managed at a tertiary hospital between June 2021 and December 2023 were identified by reviewing S. aureus-positive blood cultures through microbiological informatics systems. Characteristics of patients and infectious episodes were compared between the standard full-IV treatment and the oral switch strategy.

RESULTS

Among 140 cases, 82 (58.6%) were managed with an oral switch strategy. Bone and joint infections accounted for most oral switch cases (40.2%), while central line-associated bloodstream infections predominated in the full-IV group (86.2%). All endocarditis (n = 2) and 4/10 suppurative thrombophlebitis cases underwent oral switch. Median hospital stay was significantly shorter in the oral switch group (13 days [IQR, 8-24.7] vs 48 days [IQR, 24-78.2]; P = 0.03). Thirty-day failure rates were comparable between oral switch (2/82, 2.4%) and full-IV (2/58, 3.4%) groups (adjusted risk difference 0.5%, 95% CI, -5.4 to 6.4, P = 0.86).

CONCLUSION

Oral switch, used in over half of children with SAB, may offer a safe alternative to full IV therapy. Broader prospective studies are warranted to confirm these findings.