Staphylococcus aureus (SAB) bloodstream infections affect 20–30 individuals per 100,000 population annually, carrying a 3-month mortality rate of 20–30%. The conventional treatment involves a minimum of 14 days of intravenous antimicrobial therapy. However, a recent study led by Kaasch and colleagues corroborates the effectiveness and safety of oral antibiotic therapy in pill form for SAB bloodstream infections. Published in the Journal of The Lancet Infectious Diseases, the research suggests a paradigm shift in treating such infections.
The study highlights that for patients at low risk of developing infectious complications, transitioning to early oral antibiotic therapy is as effective and safe as adhering to traditional intravenous treatment. This innovative approach not only simplifies the treatment process but also accelerates patient discharge from the hospital. SAB is a prevalent global pathogen responsible for severe bloodstream infections or sepsis. The researchers emphasize the importance of adequate SAB treatment, as failure to undergo appropriate treatment poses a serious risk of infection spreading to other body parts, and even successful treatment can impede recovery for months.
While the conventional intravenous treatment for SAB spans at least 14 days in a hospital setting, the study focused on the viability of oral therapy with pills compared to the standard intravenous approach. The researchers found that an early shift to oral antibiotic therapy after five to seven days of intravenous treatment is as safe and effective as the established standard.
The international, open-label, randomized, controlled, non-inferiority trial conducted in 31 tertiary care hospitals across Germany, France, the Netherlands, and Spain involved adult patients with low-risk SAB bloodstream infection. After 5–7 days of intravenous antimicrobial therapy, 213 out of 5063 patients were randomly assigned to switch to oral therapy (n=108) or continue intravenous therapy (n=105). The mean age was 63·5 years, with 69% male and 31% female participants. The study found that oral switch antimicrobial therapy was non-inferior to intravenous standard therapy, with no significant difference in the primary endpoint between the two groups.
Before considering the transition to early oral therapy, it is essential to closely observe patients for signs and symptoms of complicated SAB bloodstream infection, both at the time of presentation and throughout the treatment course. This cautious approach underscores the complexity of infectious disease management and emphasizes the importance of tailored strategies in the evolving landscape of medical care.
Reference
Kaasch AJ, López-Cortés LE, Rodríguez-Baño J, Cisneros JM, Navarro MD, Fätkenheuer G, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomized, controlled, non-inferiority trial. The Lancet Infectious Diseases [Internet]. 2024 Jan 17 [cited 2024 Jan 19].