The Benefits and Safety of Oral Sequential Antibiotic Therapy in Non-Complicated and Complicated Staphylococcus Aureus Bacteremia.

Background: Treatment optimization for serious infections, such as Staphylococcus aureus bacteremia (SAB), is a challenge for antimicrobial stewardship teams. Currently, SAB guidelines recommend a completely intravenous therapy (CIT). Objectives: The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB. Patients and methods: We conducted a retrospective, observational study in a tertiary teaching hospital in Spain. The inclusion criteria were complicated and non-complicated monomicrobial SAB and an adequate duration of therapy, with patients classified into OST or CIT. The primary endpoint was the 90 day recurrence of S. aureus infection. We also analyzed the mortality, the length of the hospital stay, and the duration of the intravenous antibiotic administration. Results: Of a total of 201 patients with SAB, 125 (62%) underwent OST. The most commonly administered oral antibiotic was trimethoprim-sulfamethoxazole (66% of patients). Of those administered OST, 43% had complicated bacteremia (most with an osteoarticular source of infection), and 6% had an intravascular device. The 90-day recurrence rate was 4%, with no differences between the two groups. The duration of the therapy (22 [16-28] vs.13 days [8-17] for CIT and OST, respectively; p < 0.001) and the hospital stay (36 [27-71] vs.18 days [13-29] for CIT and OST, respectively; p < 0.001) were shorter for OST. MRSA was related with mortality (OR 4.4, 95% CI [1.67-11.37]; p = 0.003). Conclusions: OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.