Implementation of oral versus intravenous antibiotics in clinical practice at a specialized orthopedic infection unit: a descriptive retrospective cohort study.

Background and purpose:  The Oral Versus Intravenous Antibiotics (OVIVA) trial demonstrated that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the initial 6 weeks in the treatment of bone and joint infections (BJIs). We aimed to evaluate clinical outcomes, antibiotic treatment details, and complication rates following the implementation of the OVIVA protocol.

Methods:  All patients treated for BJIs between September 2019 and September 2020 at the specialized orthopedic infection unit of Herlev Hospital were eligible for inclusion. This study included data on patient demographics, antibiotic regimens, type of infection, microbiology, length of stay, adverse drug reactions, and definite treatment failure at 1 year.

Results:  A cohort of 129 patients was included. After a median of 7 days of intravenous therapy, 127 patients underwent an early switch to oral antibiotics. The most frequently used class of oral antibiotics was penicillins (68%). Adverse drug reactions, mostly gastrointestinal, occurred in 36% of all patients. Definite treatment failure at 1 year was 13% with oral antibiotics.

Conclusion:  We found a comparably low failure rate of 13% among patients who were able to transition to oral antibiotics when applying the treatment protocol from the OVIVA study.