Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteremia. A propensity-matched cohort analysis

Link to article at PubMed

Clin Microbiol Infect. 2023 Feb 9:S1198-743X(23)00054-X. doi: 10.1016/j.cmi.2023.02.001. Online ahead of print.


OBJECTIVES: We aimed to analyze the efficacy and safety of oral sequential therapy (OST) in uncomplicated SAB.

PATIENTS AND METHODS: Single-centre observational cohort at a tertiary hospital in Spain including all patients with the first SAB episode from January 2015 to December 2020. We excluded patients with complicated SAB and those who died during the first week. Patients were classified into OST group (patients who received oral therapy after initial intravenous treatment (IVT)); and IVT group (patients who received exclusively intravenous treatment). We performed a propensity-score matching to balance baseline differences. The primary-composite endpoint was 90-day mortality or microbiological failure. Secondary endpoints included 90-day SAB relapse.

RESULTS: Out of 407 SAB first episodes, 230 (56,5%) were included. Of these, 112 (n=48.7%) received OST and 118 (51.3%) IVT exclusively. Transition to oral therapy was done after 7 days (IQR 4-11). The primary endpoint occurred in 10.7% (11/112) in OST versus 30.5% (36/118) in IVT (p<0.001). SAB relapses occurred in 3.6% (4/112) versus 1.7% (2/118) (p=0.436) None of the deaths in OST were related to SAB or its complications. After propensity-score matching, the primary endpoint was not more frequent in OST group (relative risk 0.42, 95% confidence interval 0.22-0.79). Ninety-day relapses occurred similarly in both groups (relative risk 1.35, 95% confidence interval 0.75-2.39).

CONCLUSION: After initial intravenous antibiotic, patients with uncomplicated SAB can safely be switched to oral antibiotic without apparent adverse outcome. This strategy could save costs and complications of prolonged hospital stays. Prospective randomized studies are needed.

PMID:36773773 | DOI:10.1016/j.cmi.2023.02.001

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