The Gram-negative bloodstream infection Oral Antibiotic Therapy trial (The GOAT Trial) is a multi-center, randomized clinical trial that hypothesizes that early transition to oral antibiotic therapy for the treatment of Gram-Negative BloodStream Infection (GN-BSI) is as effective but safer than remaining on intravenous (IV) antibiotic therapy for the duration of treatment.
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Eligibility Criteria
Inclusion Criteria:
* Adult (≥ 18 years) at the time of screening
* Hospitalized
* Identification of at least one Gram-negative organism in a blood culture
* Capable of providing written informed consent (includes through a legally authorized representative)
* Willingness to adhere to assigned stud…
Inclusion Criteria:
* Adult (≥ 18 years) at the time of screening
* Hospitalized
* Identification of at least one Gram-negative organism in a blood culture
* Capable of providing written informed consent (includes through a legally authorized representative)
* Willingness to adhere to assigned study arm
* Capable and willing to complete a follow-up QoL interview (including through a legally authorized representative)
Exclusion Criteria:
* Unable to tolerate or absorb a course of oral antibiotics
* Actively receiving vasopressors
* Gram-negative organism not susceptible to any oral antibiotics
* Gram-negative organism not susceptible to any IV antibiotics
* Polymicrobial bloodstream infection
* The following patients with polymicrobial infections remain eligible for enrollment: (1) more than one morphology or species of a gram-negative organism (except for Acinetobacter baumannii or Stenotrophomonas maltophilia), (2) a single positive blood culture with a common commensal organism (grown in addition to an Enterobacterales species or Pseudomonas aeruginosa
* Allergy or contraindication rendering no oral option or no IV option for therapy with the listed antibiotic agents.
* Anticipated duration of therapy greater than 14 days
* Central nervous system infection
* Absolute neutrophil count of \<500 cells/mL or anticipated to reduce to \<500 cells/mL during the antibiotic treatment course.
* Receiving hospice care
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