PSHP 2026 Residency Conference

Identify whether oral third generation cephalosporins are as effective as standard of care, ceftriaxone or vancomycin, for the treatment of penicillin-non-susceptible, ceftriaxone-susceptible alpha-hemolytic Streptococcal infections. This retrospective chart review evaluated patients > 18 years old admitted to St. Luke’s University Health Network for treatment of penicillin-non-susceptible, ceftriaxone-susceptible alpha-hemolytic Streptococcal infections from January 2017 to December 2025.  Patients were included if they received parenteral-only therapy with ceftriaxone/vancomycin or oral transition therapy with cefpodoxime/cefdinir. Sterile cultures obtained from blood, fluid, and tissue were assessed. Patients were excluded if they had deep-seated and/or polymicrobial infections or were transitioned to comfort/hospice prior to treatment completion. The primary outcome was 90-day all-cause mortality. Secondary outcomes included recurrence of infection, hospital length of stay, and treatment-related adverse events. For analysis of continuous variables, the Student’s T-test or Mann-Whitney U Test were utilized and the Chi-square or Fisher’s exact test were conducted for categorical data. A total of 409 patients were screened. Of those, 43 were included in the IV group and 9 were included in the oral transition group. The gastrointestinal tract was the most common source of infection among both groups (42.3%) and most patients had secondary bacteremia (94.2%). No significant difference in all-cause mortality at 90-days was observed between the IV-only and oral transition therapy groups (9.3% vs. 11.1%; p = 1.00). In patients that received oral-transition therapy, the total duration of definitive therapy was significantly shorter (10 vs. 15 days; p < 0.01). The median hospital length of stay was significantly shorter in the oral-transition group (5 vs. 8 days, p < 0.05). No significant difference in adverse effects was observed between the groups. It remains unclear if there is a difference in all-cause mortality or recurrence of Streptococcal infections at 90 days between the IV-only and oral transition groups.  However, results suggest oral transition therapy with cefpodoxime and cefdinir may significantly reduce median hospital length of stay and total duration of definitive therapy.