GOAT

Summary

Despite the availability of potent antimicrobial drugs and advances in supportive care, bloodstream infections (BSIs) remain a major cause of morbidity and mortality worldwide. Gram-negative (GN) rod-shaped bacteria (such as E coli, Pseudomonas) cause as many as 50% of all BSIs. These organisms pose serious treatment challenges, partially because of the increasing incidence of multidrug resistance. In addition, patients with GN-BSIs are prone to additional medical problems, including shock and sepsis.

Traditionally, GN-BSIs have been managed with intravenous (IV) antibiotics only. However, IV antibiotics may not be necessary for the entire treatment course, especially for uncomplicated episodes. For these patients, oral antimicrobial agents may be effective, thus helping to shorten hospital stays and reduce the need for outpatient IV therapy.

GOAT involves several hospitals across the U.S., including Carilion. The main study goal is to determine which is better for managing GN-BSIs:

• IV antibiotics for the full duration of treatment
• Initial IV antibiotics (for 5 days maximum) followed by oral antibiotics for the rest of the treatment period

Because U.S. hospitals already provide both options evaluated in GOAT, the study’s findings can be readily adopted and implemented to improve patient care and outcomes.

To be included in GOAT, participants must be / have

• Adult (18 years or older)
• Hospitalized
• Identification of at least one gram-negative organism on a blood culture
• Willing and able to complete a follow-up quality-of-life interview

To be included in GOAT, participants must not be / have

• Unable to receive antibiotics orally
• Receiving medications to increase blood pressure (vasopressors)
• Infection with a gram-negative organism that is not susceptible to any oral or intravenous antibiotic

Keywords

Bacteremia; Sepsis; Shock