737. Oral Antibiotic Stepdown Therapy for Uncomplicated Streptococcal

Abstract Background Streptococcus species are known pathogens in bloodstream infections (BSIs). Traditionally, BSIs are managed with intravenous (IV) antibiotics, however there is growing literature supporting oral (PO) antibiotics in BSIs as well as other invasive infections. Advantages to PO therapies include shortened hospital stay, reduced treatment costs, and avoidance of line-related complications. Currently, there is a paucity of data supporting the use of PO antibiotics in streptococcal BSIs. Methods This retrospective cohort study evaluated patients with streptococcal bacteremia between September 2019 to September 2021. Patients 18 and older were included if they had at least one positive blood culture for any Streptococcus species and excluded if BSI was polymicrobial, or treatment was for complicated BSI, identified by receipt of targeted therapy for ≥ 16 days, or source being endocarditis, osteomyelitis, or meningitis. Clinical outcomes were compared between patients who completed treatment with IV antibiotics verses those who completed with an PO stepdown regimen. The primary endpoint was clinical failure, which was a composite endpoint defined as BSI recurrence with the same pathogen and infection-related readmission within 30 days from completion of antibiotics. Results A total of 158 patients were included, with 77 (49%) receiving a full course of IV antibiotics and 81 (51%) receiving an PO antibiotic stepdown regimen. Clinical failure was not different between the IV antibiotics group versus the PO stepdown group, respectively (16% vs. 15%, odds ratio [OR] = 0.94; 95% confidence interval [CI], 0.40 to 2.25). No differences were observed in 30-day all-cause mortality. Patients that received PO antibiotic stepdown therapy had a significantly shorter hospital length of stay by 6 days (6 versus 12 days, p< 0.01). Conclusion Our results suggest that clinical cure with an PO stepdown regimen for uncomplicated streptococcal BSIs is comparable to IV antibiotics. The benefit of comparable efficacy in the setting of reduced length of stay and avoidance of central line placement for outpatient IV antibiotics should be considered when making treatment plans for patients with uncomplicated streptococcal BSIs. Disclosures All Authors: No reported disclosures.