M Teresa Pérez-Rodríguez1, Adrián Sousa2, Antonio Moreno-Flores3, Rebeca Longueira2, Patricia Diéguez4, Milagros Suárez4, Olalla Lima4, Francisco J Vasallo3, Maximiliano Álvarez-Fernández5, Manuel Crespo2. 1. Infectious Diseases Unit, Internal Medicine Department, University Hospital Complex of Vigo, Spain; Biomedical Research Institute Galicia Sur, Spain. Electronic address: perezrodriguezmt@gmail.com. 2. Infectious Diseases Unit, Internal Medicine Department, University Hospital Complex of Vigo, Spain; Biomedical Research Institute Galicia Sur, Spain. 3. Microbiology Department, University Hospital Complex of Vigo, Spain. 4. Infectious Diseases Unit, Internal Medicine Department, University Hospital Complex of Vigo, Spain. 5. Biomedical Research Institute Galicia Sur, Spain; Microbiology Department, University Hospital Complex of Vigo, Spain.
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.
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.
Authors: Laura Herrera-Hidalgo; Rafael Luque-Márquez; Aristides de Alarcon; Ana Belén Guisado-Gil; Belen Gutierrez-Gutierrez; Maria Dolores Navarro-Amuedo; Julia Praena-Segovia; Juan Manuel Carmona-Caballero; Elena Fraile-Ramos; Alicia Gutierrez-Valencia; Luis Eduardo Lopez-Cortes; Maria Victoria Gil-Navarro Journal: J Clin Med Date: 2022-03-11 Impact factor: 4.241