Rando, EmanueleDelgado-Valverde, MercedesGoikoetxea Aguirre, JosuneGuio Carrión, LauraBlanco Vidal, María JoséBarrios Andrés, José LuisPérez Rodríguez, María TeresaMartínez Lamas, LucíaArnaiz de las Revillas, FranciscoArmiñanzas, CarlosRuiz de Alegría-Puig, CarlosJiménez Aguilar, PatriciaMartínez-Rubio, María del CarmenSáez-Béjar, Carmende las Cuevas, CarmenMartín-Aspas, AndrésGalán, FátimaYuste, José RamónLeiva-León, JoséBou, GermánCapón González, PatriciaBoix-Palop, LucíaXercavins-Valls, MarionaGoenaga-Sánchez, Miguel ÁngelVicente Anza, DiegoCastón, Juan JoséRecio Rufián, ManuelMerino, EsperanzaRodríguez, Juan CarlosLoeches, BelénRosso-Fernández, ClaraBravo-Ferrer, José MaríaRetamar-Gentil, PilarRodríguez-Baño, JesúsLópez-Cortés, Luis Eduardo2025-06-032025-06-032025Rando E, Delgado-Valverde M, Aguirre JG, Carrión LG, Vidal MJB, Andrés JLB, Rodríguez MTP, Lamas LM, Arnaiz de Las Revillas F, Armiñanzas C, de Alegría-Puig CR, Aguilar PJ, Martínez-Rubio MDC, Sáez-Béjar C, de Las Cuevas C, Martín-Aspas A, Galán F, Yuste JR, Leiva-León J, Bou G, González PC, Boix-Palop L, Xercavins-Valls M, Goenaga-Sánchez MÁ, Anza DV, Castón JJ, Rufián MR, Merino E, Rodríguez JC, Loeches B, Rosso-Fernández C, Bravo-Ferrer JM, Retamar-Gentil P, Rodríguez-Baño J, Cortés LEL; SIMPLIFY Study Group. Effectiveness of oral step-down therapy and early oral switch for bloodstream infections caused by Enterobacterales: a post hoc emulation trial of the SIMPLIFY trial. Int J Infect Dis. 2025 Apr 29;156:1079171201-9712http://hdl.handle.net/2183/42141[Abstract] Objectives: We investigated the effectiveness of early oral switch for treating Enterobacterales bloodstream infection (BSI) by performing a post hoc emulation trial of the SIMPLIFY trial. Methods: We conducted a post hoc analysis of a randomized controlled trial. We specified the target trial characteristics selecting patients who achieved clinical stability on day 5. We categorized patients into those who switched on day 5 and those who continued intravenously. The primary outcome was clinical cure at the test of cure. We set a propensity score for being switched on day 5 to reduce confounding. We ran simple, not-propensity-adjusted, and propensity-adjusted logistic regression models to ascertain the association of switch on day 5 with clinical cure. Results: Among 303 patients who achieved clinical stability on day 5, 110 (36.3%) were switched orally on day 5, and 193 (63.7%) were kept intravenously. We detected no difference in clinical cure between those switched on day 5 and those continued intravenously (risk ratios 1.04, 95% confidence intervals [CI] 0.98-1.10). Propensity-adjusted analysis did not show an association between day 5 switch and clinical cure (OR 2.10, 95% CI 0.96-7.41). Conclusion: Oral step-down therapy on day 5 was not associated with worse clinical cure for Enterobacterales BSI.engCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC-BY-NC-ND 4.0)http://creativecommons.org/licenses/by-nc-nd/3.0/es/Antimicrobial stewardshipBloodstream infectionEnterobacteralesOral switchjournal articleopen access10.1016/j.ijid.2025.107917