The benefits and safety of oral sequential antibiotic therapy in non-complicated and complicated Staphylococcus aureus bacteremia

Int J Infect Dis. 2021 Jan:102:554-560. doi: 10.1016/j.ijid.2020.10.097. Epub 2020 Nov 4.

Abstract

Background: Treatment optimization for serious infections, such as Staphylococcus aureus bacteremia (SAB), is a challenge for antimicrobial stewardship teams. Currently, SAB guidelines recommend a completely intravenous therapy (CIT).

Objectives: The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB.

Patients and methods: We conducted a retrospective, observational study in a tertiary teaching hospital in Spain. The inclusion criteria were complicated and non-complicated monomicrobial SAB and an adequate duration of therapy, with patients classified into OST or CIT. The primary endpoint was the 90-day recurrence of S. aureus infection. We also analyzed the mortality, the length of the hospital stay, and the duration of the intravenous antibiotic administration.

Results: Of a total of 201 patients with SAB, 125 (62%) underwent OST. The most commonly administered oral antibiotic was trimethoprim-sulfamethoxazole (66% of patients). Of those administered OST, 43% had complicated bacteremia (most with an osteoarticular source of infection), and 6% had an intravascular device. The 90-day recurrence rate was 4%, with no differences between the two groups. The duration of the therapy (22 [16-28] vs. 13 days [8-17] for CIT and OST, respectively; p < 0.001) and the hospital stay (36 [27-71] vs. 18 days [13-29] for CIT and OST, respectively; p < 0.001) were shorter for OST. MRSA was related with mortality (OR 4.4, 95% CI [1.67-11.37]; p = 0.003).

Conclusions: OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay.

Keywords: Complicated bacteremia; Oral sequential therapy; Recurrence; Safety; Staphylococcus aureus bacteremia.

Publication types

  • Observational Study

MeSH terms

  • Administration, Intravenous
  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Antimicrobial Stewardship*
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Bacteremia / mortality
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spain
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / mortality
  • Staphylococcus aureus / drug effects*
  • Tertiary Care Centers
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage*

Substances

  • Anti-Bacterial Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination