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Clin Microbiol Infect. 2019 Jul 26. pii: S1198-743X(19)30411-2. doi: 10.1016/j.cmi.2019.07.019. [Epub ahead of print]

Association between treatment duration and mortality or relapse in adult patients with Staphylococcus aureus bacteraemia: a retrospective cohort study.

Author information

1
Infection Control Programme; Service of Infectious Diseases. Electronic address: Mohamed.abbas@hcuge.ch.
2
Service of General Internal Medicine.
3
Infection Control Programme.
4
Infection Control Programme; Clinical Trials Unit.
5
Service of Infectious Diseases; Bacteriology Laboratory; University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
6
Infection Control Programme; Service of Infectious Diseases.
7
Service of Infectious Diseases.
8
Infection Control Programme; Service of Infectious Diseases; (6)Balgrist University Hospital, Zurich, Switzerland.

Abstract

OBJECTIVES:

To evaluate the effect of duration of therapy (DOT) on mortality and relapse for patients with Staphylococcus aureus bacteraemia (SAB).

METHODS:

We performed a retrospective single-centre cohort study including adult patients with SAB. We determined the association between DOT (≤14 days versus >14 days) and mortality by adjusted hazard ratios (aHR) and 95% confidence intervals through Cox regression adjusted for immortal-time bias and confounding by indication, stratified by presence of complicated SAB (any of: endocarditis, implant, duration of SAB >2 days, fever >3 days). The primary outcome was 90-day all-cause mortality, secondary outcome was 90-day relapse.

RESULTS:

Between January 2010 and December 2015, we included 530 patients, of whom 94/530 (17.7%) had methicillin-resistant SAB and 305/530 (57.6%) had complicated SAB. Ninety-day mortality was 27.0% (143/530), with no significant trend across study period; median time to death was 17 days (interquartile range, IQR, 8-30) after onset of SAB. Median DOT was 20 days (IQR 13-39). Patients with complicated SAB had significantly reduced mortality with DOT >14 days (aHR 0.32, 95% CI 0.16-0.64). DOT was not associated with mortality in patients with uncomplicated SAB (aHR 0.85; 0.41-1.78). Eighteen (18/530) patients (3.4%) relapsed; on univariate analysis, DOT was not associated with relapse (HR 1.01; 0.97-1-06).

CONCLUSIONS:

DOT >14 days is associated with higher survival in patients with complicated SAB, but not for patients with uncomplicated SAB. No association was found for relapse, but 90-day relapse was very low in this cohort. Importantly, 90-day mortality remained high across the study period.

KEYWORDS:

Staphylococcus aureus; bacteraemia; duration of antibiotic therapy; mortality

PMID:
31357013
DOI:
10.1016/j.cmi.2019.07.019

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