Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis

Diego-Yagüe, Itziar; Mora-Vargas, Alberto; Vázquez-Comendador, José; Santamarina-Alcantud, Beatriz; Múñez-Rubio, Elena; Gutiérrez-Villanueva, Andrea; Sánchez-Romero, Isabel; Moreno-Torres, Víctor; Ramos‐Martínez, Antonio; Calderón-Parra, Jorge

doi:10.1016/j.cmi.2023.02.001

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…Several retrospective studies have been published data about safety and efficacy of oral step-down in patients with bacteremia from S. aureus. Diego-Yagüe et al found no difference in 90-day microbiological failure, relapse, and mortality when patients with uncomplicated bacteremia who had already received IV treatment for a median of one week underwent oral de-escalation compared with a cohort that received IV-only therapy; approximately one-third of the subjects received oral fluoroquinolones and another half of them oral beta-lactams [60]. Oral beta-lactams (mainly flucloxacillin 1 g tid) were also predominantly prescribed to 81 low-risk, mostly CRBSI, bloodstream infections in a retrospective study from New Zealand, when 5 days of IV treatment had preceded [61].…”

Section: Gram-positive Bacteremia S Aureus Bacteremia: Clinical Effic...mentioning

confidence: 99%

Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

Eleftheriotis,

Marangos,

Lagadinou

et al. 2023

Microorganisms

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Bacteremia and endocarditis are two clinical syndromes that, for decades, were managed exclusively with parenteral antimicrobials, irrespective of a given patient’s clinical condition, causative pathogen, or its antibiotic susceptibility profile. This clinical approach, however, was based on low-quality data and outdated expert opinions. When a patient’s condition has improved, gastrointestinal absorption is not compromised, and an oral antibiotic regimen reaching adequate serum concentrations is available, a switch to oral antibacterials can be applied. Although available evidence has reduced the timing of the oral switch in bacteremia to three days/until clinical improvement, there are only scarce data regarding less than 10-day intravenous antibiotic therapy in endocarditis. Many standard or studied oral antimicrobial dosages are smaller than the approved doses for parenteral administration, which is a risk factor for treatment failure; in addition, the gastrointestinal barrier may affect drug bioavailability, especially when the causative pathogen has a minimum inhibitory concentration that is close to the susceptibility breakpoint. A considerable number of patients infected by such near-breakpoint strains may not be potential candidates for oral step-down therapy to non-highly bioavailable antibiotics like beta-lactams; different breakpoints should be determined for this setting. This review will focus on summarizing findings about pathogen-specific tailoring of oral step-down therapy for bacteremia and endocarditis, but will also present laboratory and clinical data about antibiotics such as beta-lactams, linezolid, and fosfomycin that should be studied more in order to elucidate their role and optimal dosage in this context.

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Section: Gram-positive Bacteremia S Aureus Bacteremia: Clinical Effic...mentioning

confidence: 99%

Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

Eleftheriotis,

Marangos,

Lagadinou

et al. 2023

Microorganisms

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“…Recent retrospective, observational studies found similar outcomes for oral switch therapy in patients with SAB. 5,6,[13][14][15][16][17][18][19] However, retrospective studies have a high risk of confounding by indication. Consequently, less than 20% of infectious disease physicians from the US and Canada felt comfortable with switching to oral medication in SAB as two recent surveys demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Early oral switch in low-riskStaphylococcus aureusbloodstream infection

Kaasch

López-Cortés

Rodríguez‐Baño

et al. 2023

Preprint

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Background: Staphylococcus aureus bloodstream infection (SAB) is treated with at least 14 days of intravenously administered antimicrobials. We assessed the efficacy and safety of an early oral switch therapy in patients at low risk for SAB-related complications. Methods: In an international non-inferiority trial, we randomized patients with SAB after 5 to 7 days of intravenous antimicrobial therapy to either switch to an oral antimicrobial or to continue with intravenous standard therapy. Main exclusion criteria were signs and symptoms of complicated SAB, non-removable foreign devices, and severe comorbidity. Composite primary endpoint was the occurrence of any SAB-related complication (relapsing SAB, deep-seated infection, and mortality attributable to SAB) within 90 days. Results: 213 patients were randomized into the intention-to-treat population. In the oral switch group, 14/108 (13%) participants reached the primary endpoint versus 13/105 (12%) in the standard therapy group (adjusted difference 0.7%, 95% confidence interval [CI] -7.8% to 9.1%). Participants in the oral switch group were discharged earlier (median hospital stay from SAB onset of 12 days versus 16 days; adjusted difference -3.1 days [95% CI -7.5 to 1.4]). There was no statistical difference in 30-day survival and complications of intravenous administration. More participants in the oral group experienced at least one serious adverse event (34% versus 26%, p=0.292). Conclusion: Oral switch was non-inferior to intravenous standard therapy in participants with low-risk SAB. However, a careful assessment of patients for signs and symptoms of complicated SAB at time of presentation and thereafter is necessary before considering early oral switch therapy.

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One Small Step (Down) for Antibiotics, One Giant Leap for Outpatient Therapy: The Role of Oral Antibiotics in Serious Bacterial Infections

Ortwine,

Wei,

Mang

et al. 2023

Curr Infect Dis Rep

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Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis

Cited by 7 publications

References 33 publications

Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives

Early oral switch in low-riskStaphylococcus aureusbloodstream infection

One Small Step (Down) for Antibiotics, One Giant Leap for Outpatient Therapy: The Role of Oral Antibiotics in Serious Bacterial Infections

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