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• Persons who inject drugs with Serratia bacteraemia are younger compared with non-users. • Persons who inject drugs with Serratia bacteraemia are less morbid than non-users. • Persons who inject drugs have a higher rate of Serratia infective endocarditis. • Serratia infective endocarditis guidelines recommend combination antibiotic therapy. • Long-term outcomes of persons who inject drugs are comparable with non-users. Serratia marcescens (S. marcescens) is an Enterobacterales species present throughout the environment and causes a range of infections. Historically, S. marcescens has been associated with persons who inject drugs (PWID), but literature is scarce. This study aimed to compare treatment characteristics and clinical outcomes between PWID and non-PWID with Serratia marcescens bacteraemia. This was a retrospective cohort study of patients hospitalised with S. marcescens bacteraemia from 1 January 2013 to 31 December 2019 at a tertiary medical centre. Patients were included if they were aged ≥ 18 years and had at least one positive blood culture for S. marcescens. Of the 67 patients who met inclusion criteria, 14 were identified as PWID (21%) and 53 were non-PWID (79%). Persons who inject drugs were younger (median age: PWID 32 years, non-PWID 67 years) and less likely to have renal disease (PWID 7%, non-PWID 34%). Persons who inject drugs had a higher incidence of infective endocarditis (IE) (PWID 48%, non-PWID 0%) and were more likely to receive combination antimicrobial therapy (PWID 29%, non-PWID 2%). All-cause mortality at 12 months was comparable between groups (PWID 21%, non-PWID 21%). This study demonstrates that long-term outcomes of PWID are comparable with non-PWID, despite PWID being a younger cohort with fewer comorbidities. Clinicians should have high suspicion of IE in PWID with S. marcescens bacteraemia. [ABSTRACT FROM AUTHOR]

• The frequency of clinical failure was similar in the continued IV and PO step-down groups (24.2% vs. 18.0%, P =0.23). • Hospital length of stay was longer in the IV group compared with the PO group (7 [5-13.5] vs. 4 [3–5] days, P <0.001). • The incidence of antibiotic adverse events was similar in the IV and PO groups (1.3% vs. 1.8%, P =0.74). The purpose of this study was to compare the clinical outcomes of adults with uncomplicated streptococcal bacteremia who received either oral (PO) step-down or continued intravenous (IV) therapy. This was a retrospective, single-center, cohort study, including adults admitted with Streptococcal bloodstream infection between January 1, 2013, and December 31, 2020. Only patients with uncomplicated Streptococcal bloodstream infections were included. Patients who transitioned to PO therapy within 5 days from bacteremia onset were compared to patients receiving continued IV therapy. The primary outcome was clinical failure, defined by either 90-day hospital readmission or mortality. Secondary outcomes included hospital length of stay (LOS) and antibiotic-related adverse events (AAEs). Of the 264 patients included, 42% were transitioned to PO therapy. Group B Streptococcus (22.7%) was the most common isolate. The most common sources of infection were skin and soft tissue (35%) and pulmonary (25%). Intensive care unit (ICU) stay was more common in the continued IV therapy group (22.2%) than in the PO step-down group (5.4%). The frequency of clinical failure was similar in the IV and PO groups (24.2% vs. 18.0%, P =0.23). The IV group had longer hospital LOS (median, [interquartile range (IQR)]) compared with the PO group (7 [5-13.5] vs. 4 [3–5] days, P <0.001). The incidence of AAEs was similar in the IV and PO groups (1.3% vs. 1.8%, P =0.74). Oral antibiotic step-down therapy may be appropriate for the treatment of uncomplicated Streptococcal bacteremia, with consideration of factors such as patient comorbidities, type of infection, source control and clinical progress. [ABSTRACT FROM AUTHOR]