Management of GNR bacteremia in HCT: shifting patterns for outpatient antibiotic therapy in the modern era

Gram-negative rod bacteremia (GNRB) is a leading cause of morbidity and mortality in recipients of an allogeneic hematopoietic cell transplant (HCT). Treatment for these patients has historically occurred in the inpatient setting; however, shifts have been made towards outpatient care as it is associated with lower rates of hospital acquired infections (HAIs) and better use of hospital resources. Our objective was to identify clinical predictors at the time of GNRB diagnosis that would determine whether a patient spent a majority of their treatment days outpatient. Multivariate logistic regression analysis revealed that patients without severe gut graft vs. host disease (GVHD) (OR = 10.31, 95% CI = 4.89, 23.03), patients without neutropenia (OR = 8.96, 95% CI = 4.58, 18.42) and patients who received an outpatient GNRB diagnosis (OR = 8.59, 95% CI = 3.26, 27.22) were significantly more likely to receive greater than 50% of their antibiotic regimen in the outpatient setting. Further studies examining clinical predictors for outpatient care among GNRB patients are needed to better target antimicrobial stewardship, infection prevention and patient education interventions.