Intravenous to Oral Switch in Complicated <i>Staphylococcus aureus</i> Bacteremia Without Endovascular Infection: A Retrospective Single-Center Cohort Study

Kouijzer, Ilse J.E.; Leerdam, Eline J van; Gompelman, Michelle; Tuinte, Renée A M; Aarntzen, Erik H.J.G.; Berrevoets, Marvin A.H.; Maat, Ianthe; Bleeker‐Rovers, Chantal P.; Crevel, Reinout van; Oever, Jaap ten

doi:10.1093/cid/ciab156

Cited by 26 publications

(28 citation statements)

References 10 publications

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“…In our study, the broad majority of patients had SAB secondary to bone, joint, or muscle infections (84.5%). This is expected based on etiology studies in pediatrics [ 3 , 4 ] and is similar to the study by Kouijzer et al [ 17 ]. Other studies from Bupha-Intr and Willekens and colleagues evaluated oral therapy for adults with SAB and revealed that the majority of the patients had line-associated infections [ 16 , 18 ].…”

Section: Discussionsupporting

confidence: 90%

“…Patients who received oral step-down therapy in our study experienced a low rate of 30-day readmission (5.3%) and no SAB-attributable mortality. This is similar to studies by Kouijzer (no relapse, 6.6% mortality), Bupha-Intr (1% relapse in 90 days, no attributable mortality), and Willekens (2.2% 90-day relapse, 2.2% mortality) [ 16 , 17 , 18 ]. In addition, these results mirror those seen in previous studies of bacteremic S. aureus osteomyelitis [ 5 , 14 , 22 ].…”

Section: Discussionsupporting

confidence: 90%

“…Their analysis found that the length of hospital stay was shorter in the oral step-down group, with a length of stay nearly matching our cohort (median of 8.5 days in the oral step-down group vs. 11 days in the IV group; p = 0.006) [ 5 ]. Similar to our study, Willekens and Kouijzer and colleagues found longer lengths of stay in the IV groups as compared to the oral step-down groups (median 19 vs. 8 days ( p < 0.01) and median 26 vs. 17 days ( p = 0.001), respectively) [ 17 , 18 ]. In contrast to our study, there was no difference in the total duration of treatment between groups in the studies by Kouijzer (median 45 days for both), Willekens (median 15 days for both), and Bupha-Intr (median 16 vs. 14 days) [ 16 , 17 , 18 ].…”

Section: Discussionsupporting

confidence: 89%

“…The use of oral antibiotics for SAB has yet to be validated by prospective, randomized controlled trials and has only been evaluated by a select few studies, most of which involved subgroup analyses of larger studies where the predominant number of patients were nonbacteremic [ 5 , 13 , 14 , 15 ]. Two retrospective [ 16 , 17 ] and one prospective cohort [ 18 ] studies that evaluated oral therapy for adult patients with SAB demonstrated low incidence of complications and similar mortality to patients who received a full course of intravenous therapy. It is important to note that these studies included a majority of patients with low-risk methicillin-susceptible SAB, which limits applicability in settings of higher acuity, more serious infections, or where methicillin resistance may be more prevalent.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

et al. 2022

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Limited data are available regarding optimal antimicrobial therapy for Staphylococcus aureus bacteremia (SAB) in pediatric patients. The purpose of this study was to assess clinical characteristics and outcomes associated with intravenous (IV) versus oral step-down treatment of pediatric SAB. This study evaluated patients aged 3 months to 18 years that received at least 72 h of inpatient treatment for SAB. The primary endpoint was 30-day readmission. Secondary endpoints included hospital length of stay and inpatient mortality. One hundred and one patients were included in this study. The median age was 7.9 years. Patients who underwent oral step-down were less likely to be immunocompromised and more likely to have community-acquired SAB from osteomyelitis or skin and soft tissue infection (SSTI). More patients in the IV therapy group had a 30-day readmission (10 (25.6%) vs. 3 (5.3%), p = 0.006). Mortality was low (5 (5%)) and not statistically different between groups. Length of stay was greater in patients receiving IV therapy only (11 vs. 7 days, p = 0.001). In this study, over half of the patients received oral step-down therapy and 30-day readmission was low for this group. Oral therapy appears to be safe and effective for patients with SAB from osteomyelitis or SSTIs.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

et al. 2022

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“…Integration of [ 18 F]FDG-PET/CT into the diagnostic workup of patients with SAB reduces mortality rates [8][9][10]. Proof of concept studies indicate that [ 18 F]FDG-PET/CT can also be used to select patients who are eligible for iv-oral switch [11] or shortening of antibiotic treatment [12]. Therefore, implementation of [ 18 F]FDG-PET/CT during the diagnostic work-up might contribute to an individualized treatment plan.…”

Section: Introductionmentioning

confidence: 99%

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

et al. 2021

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Purpose [18F]FDG-PET/CT scanning can help detect metastatic infectious foci and reduce mortality in patients with Staphylococcus aureus bacteremia (SAB), but it is unknown if patients with SAB and an indication for prolonged treatment because of possible endovascular, orthopaedic implant, or other metastatic infection still need [18F]FDG-PET/CT. Methods In a retrospective single-center cohort study, we included all consecutive adult patients with SAB between 2013 and 2020 if an [18F]FDG-PET/CT scan was performed and antibiotic treatment was planned for ≥ 6 weeks prior to [18F]FDG-PET/CT. We aimed to identify patients for whom treatment was adjusted due to the results of [18F]FDG-PET/CT, and assessed concordance of [18F]FDG-PET/CT and clinical diagnosis for infected prosthetic material. Results Among 132 patients included, the original treatment plan was changed after [18F]FDG-PET/CT in 22 patients (16.7%), in the majority (n = 20) due to diagnosing or rejecting endovascular (graft) infection. Antibiotic treatment modifications were shortening in 2, iv-oral switch in 3, extension in 13, and addition of rifampicin in 4 patients. Ninety additional metastatic foci based on [18F]FDG-PET/CT results were found in 69/132 patients (52.3%). [18F]FDG-PET/CT suggested vascular graft infection in 7/14 patients who lacked clinical signs of infection, but showed no infection of prosthetic joints or osteosynthesis material in eight patients who lacked clinical signs of such an infection. Conclusion [18F]FDG-PET/CT can help refine treatment for SAB in patients with clinically suspected endovascular infection or vascular grafts, even if 6 weeks treatment is already indicated, but can be safely omitted in other patients who are clinically stable.

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Oral stepdown in Gram‐positive bloodstream infections: A step in the right direction

2023

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Bloodstream infections (BSIs) are associated with significant shortand long-term morbidity and mortality. [1][2][3] It is estimated there are over 536,000 BSIs in the United States annually, contributing to at least 72,000 deaths. 1 Among these, Gram-positive organisms are the causative pathogen in approximately one-half of cases. 4 Staphylococcus aureus and Enterococcus spp. are the most frequently identified Gram-positive organisms contributing to BSI, followed by coagulase-negative Staphylococcus spp. and Streptococcus spp. 4 The main pillars of BSI management, including those caused by Gram-positive pathogens, are source control and antimicrobial therapy. 5 Traditionally, intravenous antimicrobials have been utilized due to bioavailability concerns with oral therapy. 6 Undoubtedly, acutely ill patients benefit from early administration of active intravenous antimicrobials due to their rapid attainment of therapeutic drug concentrations. [7][8][9][10] The use of intravenous therapy in those who are clinically stable, however, may add significant burden to patients and health care systems alike given the prolonged treatment duration often required in BSIs. 7,11 Thus, the necessity of intravenous therapy for the entire treatment course has been increasingly called into question.Oral stepdown therapy is the practice of converting from an intravenous drug to an active oral agent, which may be an interchange to a medication in the same class or a different class altogether. 12 This differs from sequential therapy, in which an intravenous medication is converted to the oral formulation of the same compound. 12 Sequential therapy is ideal as patient tolerability is already known, preventing delays in care or discharge. This type of conversion is not always possible due to the lack of bioavailable oral formulations

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Intravenous to Oral Switch in Complicated Staphylococcus aureus Bacteremia Without Endovascular Infection: A Retrospective Single-Center Cohort Study

Cited by 26 publications

References 10 publications

Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

Oral stepdown in Gram‐positive bloodstream infections: A step in the right direction

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