Transitioning from intravenous to oral antibiotic therapy for Escherichia coli bacteremia could reduce the length of hospital stay and drug costs without compromising efficacy. Despite the expansion of extended-spectrum β-lactamase (ESBL)-producing E. coli, only limited data are available regarding the effectiveness of switching to oral antibiotic therapy in patients with bacteremia caused by this organism. To compare clinical outcomes between oral transition therapy and intravenous therapy in patients with bacteremia due to ESBL-producing E. coli with a urinary source, we conducted a retrospective cohort study at 3 Japanese hospitals. Effects were estimated by Cox hazard analysis using propensity scores. Among 996 patients with bacteremia due to E. coli, 73 were included. In the adjusted analysis weighted by propensity scores including 26 patients in the oral switch group and 47 in the intravenous group, oral transition did not increase the risk of treatment failure within 60 days (adjusted hazard ratio 0.86, 95% confidence interval 0.18–4.10), whereas the length of hospital stay was shorter in the oral switch group than in the intravenous group (median, 12 days vs. 19 days, P=0.04). Intravenous-to-oral transition may be an effective treatment option that shortens the hospital stay.

大肠杆菌菌血症从静脉注射到口服抗生素治疗的过渡可以在不影响疗效的情况下减少住院时间和药物成本。尽管产生超广谱 β-内酰胺酶 (ESBL) 的大肠杆菌出现了扩张，但关于转为口服抗生素治疗由该微生物引起的菌血症患者的有效性的数据有限。为了比较口服过渡治疗和静脉治疗在尿源性产 ESBL大肠杆菌引起的菌血症患者中的临床结果，我们在 3 家日本医院进行了一项回顾性队列研究。 使用倾向评分通过 Cox 危害分析估计效果。在 996 例菌血症患者中大肠杆菌，73 被包括在内。在倾向评分加权的调整分析中，包括 26 名患者在口服转换组和 47 名在静脉组，口服转换没有增加 60 天内治疗失败的风险（调整后的风险比 0.86，95% 置信区间 0.18-4.10） ，而口服转换组的住院时间比静脉组短（中位数，12 天 vs. 19 天，P=0.04）。静脉到口腔的过渡可能是一种有效的治疗选择，可以缩短住院时间。