Shorter antibiotic course does not increase mortality in patients with MSSA bacteremia
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Patients with low-risk methicillin-susceptible Staphylococcus aureus bacteremia who received short or prolonged antibiotic courses experienced similar mortality rates and clinical outcomes, according to a study.
The analysis, which was published in Clinical Infectious Diseases, compared clinical outcomes of patients who received 6 to 10 days or 10 to 16 days of antibiotics.
“The results of the current study substantiate the hypothesis that shortening antibiotic treatment durations in patients with low-risk S. aureus bacteremia may be possible without affecting treatment efficiency,” Louise Thorlacius-Ussing, MD, a PhD student at Copenhagen University Hospital’s Center of Research & Disruption of Infectious Diseases, and colleagues wrote. “These reassuring findings warrant further investigations in a randomized setting.”
Thorlacius-Ussing and colleagues assessed the outcomes of 1,005 patients with low-risk S. aureus bacteremia in three independent cohorts from 1995 to 2018. In the cohorts, the median treatment duration among patients who received short-course therapy was 8 days, 9 days and 8 days. It was 14 days, 14 days and 13 days in the prolonged-course groups.
The researchers observed no significant difference in 90-day mortality in any of the cohorts — with ORs of 0.85 (95% CI, 0.49-1.41), 1.24 (95% CI, 0.6-2.62) and 1.15 (95% CI, 0.24-4.019), respectively. No association was found between duration of antibiotic therapy and risk for relapse, they reported.
In a related editorial Steven Y.C. Tong MBBS, PhD, FRACP, an honorary fellow of the Menzies School of Health Research in Darwin, Australia, and Genevieve Walls, MBChB, FRACP, from the department of infectious diseases at Middlemore Hospital in Auckland, New Zealand, said the study has “many strengths” and “may be the largest low-risk S. aureus bacteremia patient cohort published to date.”
“The growing interest, evidenced by the conduct of observational studies and now clinical trials, indicates that the Overton window for shorter durations of treatment for S. aureus bacteremia is finally creaking open,” Tong wrote.
References:
Thorlacius-Ussing L, et al. Clin Infect Dis. 2021;doi:10.1093/cid/ciab201.
Tong SYC, Walls G. Clin Infect Dis. 2021;doi:10.1093/cid/ciab205.
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