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

• Published in: International journal of infectious diseases Vol. 102; pp. 554 - 560
• Main Authors: Pérez-Rodríguez, M. Teresa, Sousa, Adrián, Moreno-Flores, Antonio, Longueira, Rebeca, Diéguez, Patricia, Suárez, Milagros, Lima, Olalla, Vasallo, Francisco J., Álvarez-Fernández, Maximiliano, Crespo, Manuel
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.01.2021; Elsevier
• Subjects: Administration, Intravenous; Administration, Oral; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antimicrobial Stewardship; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Complicated bacteremia; Female; Humans; Length of Stay; Male; Middle Aged; Oral sequential therapy; Recurrence; Retrospective Studies; Safety; Spain; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcus aureus - drug effects; Staphylococcus aureus bacteremia; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage; Spain; Recurrence; Complicated bacteremia; Safety; Oral sequential therapy; Staphylococcus aureus bacteremia
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.10.097

•Staphylococcus aureus bacteremia is associated with high morbidity and mortality.•Its adequate management includes long-term intravenous therapy.•Oral sequential therapy could be a safe option in selected patients. 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). The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB. 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. 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). OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay.