Oral therapy noninferior to IV for treating low-risk S. aureus bloodstream infections
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Key takeaways:
- Oral antibiotics are safe and effective for patients with low-risk S. aureus bacteremia.
- Early oral switch can be considered after 5 to 7 days.
Making an early switch to oral antibiotic therapy from IV therapy is safe and effective for patients with low-risk Staphylococcus aureus bloodstream infection, researchers determined.
“It has been a longstanding question for clinicians whether oral therapy of S. aureus bacteremia is safe and effective. The dogma was that S. aureus bloodstream infections need to be treated intravenously,” Achim J. Kaasch, MD, head of the Institute for Medical Microbiology and Hospital Hygiene at the Otto von Guericke University of Magdeburg, told Healio.
“To sort this out, we conducted this trial ... [focusing] on patients with a low risk for complicated S. aureus bacteremia, who are usually treated with antimicrobials for 14 days,” he said.
Kaasch and colleagues conducted an international, open-label, randomized, controlled, noninferiority trial at 31 tertiary care hospitals in Germany, France, the Netherlands and Spain. All adult patients with low-risk S. aureus bloodstream infection were randomly assigned after 5 to 7 days of IV antimicrobial therapy to receive either oral antimicrobial therapy or to continue IV standard therapy.
The primary endpoint of the study was the occurrence of any complication related to S. aureus bloodstream infection such as relapsing S. aureus bloodstream infection, deep-seated infection and mortality attributable to infection within 90 days. Adverse events were also assessed in any patients who received at least one dose of study medication.
Of 5,063 patients with S. aureus bloodstream infection assessed, 213 were randomly assigned to switch to oral therapy (n = 108) or to continue IV therapy (n = 105).
Among patients switched to oral therapy, 14 (13%) met the primary endpoint of having a complication related to S. aureus bloodstream infection or a missing outcome within 90 days vs. 13 (12%) in the IV group, with a treatment difference of 0.7 percentage points (95% CI, –7.8 to 9.1), although they noted that noninferiority was achieved in both populations.
In the oral switch group, 36 (34%) of 107 participants in the safety population had at least one serious adverse event compared with 27 (26%) of 103 participants in the IV group. Specifically, the researchers found that the most common adverse events were infections, with 45 events recorded in 40 (19%) participants.
The rate of serious adverse events per person per month was 0.21 (95% CI, 0.15-0.29) in the oral switch group and 0.14 (0.1-0.2) in the IV group, with a rate ratio of 1.54 (95% CI, 0.95-2.5).
“Early oral switch can be considered after 5 to 7 days in low-risk Staphylococcus aureus bacteremia patients,” Kaasch said. “However, you have to evaluate the patients carefully whether they belong to the low-risk category and monitor them for complications.”
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