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Treatment algorithm reduces duration of antibiotic therapy
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SAN DIEGO — A novel treatment algorithm reduced the duration of antibiotic therapy for staphylococcal bloodstream infections without significantly increasing the incidence of serious adverse events, according to results of a randomized controlled trial.
“The optimal treatment duration for staphylococcal bacteremia is unknown. Incorrectly treating patients with either long-course or short-course therapy puts them at risk,” Thomas L. Holland, MD, an infectious disease specialist at Duke University Medical Center, said in a presentation at IDWeek. “If the duration is too long, you increase the risk of antibiotic resistance and antibiotic-associated adverse events. On the other hand, if the duration is too short, there is a risk for relapse.”
The analysis included 509 patients with suspected staphylococcal bloodstream infections (BSIs) at 16 health care facilities in the United States and Spain. Holland said 255 patients received treatment based on an algorithm that predicts whether they can be safety treated with shorter antibiotic courses. Their outcomes were compared with 254 patients who received standard of care.
The overall rate of clinical success was 82% among patients assigned to the treatment algorithm vs. 81.5% assigned to standard of care (0.5% difference; 95% CI, –5.2% to 6.1%). The largest difference in clinical success was observed among patients with complicated S. aureus infections, according to Holland. In these patients, the cure rate was 82.6% among those assigned to the treatment algorithm vs. 35.7% among those assigned to standard of care (absolute difference = 49.6%; 95% CI, 22.1-71.6).
Use of the treatment algorithm reduced almost 2 days of antibiotic therapy among patients with uncomplicated BSIs (4.4 days vs. 6.2 days). In a subset of these patients with uncomplicated coagulase-negative staphylococci BSIs, the treatment algorithm reduced 3 days of antibiotic therapy (5.3 days vs. 8.4 days). There was no significant difference in the duration of therapy among patients with uncomplicated Staphylococcus aureus in the treatment algorithm and standard of care arms (15.3 days vs. 15.9 days).
Holland said that rates of serious adverse events (32.5% vs. 28.3%) and mortality (6.7% vs. 5.9%) were similar between patients who were assigned the algorithm and those who received standard of care.
“Use of this treatment algorithm for staphylococcal bacteremia shortens therapy without compromising outcomes, he concluded. “This algorithm provides a means to accurately identify those patients with staphylococcal BSI for whom short course therapy is appropriate.” – by Stephanie Viguers
Reference:
Holland T, et al. Abstract 983. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.
Disclosures: Holland reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.