口服序贯抗生素疗法在非复杂性和复杂性金黄色葡萄球菌菌血症中的获益和安全性。

The benefits and safety of oral sequential antibiotic therapy in non-complicated and complicated Staphylococcus aureus bacteremia.

机构信息

Infectious Diseases Unit, Internal Medicine Department, University Hospital Complex of Vigo, Spain; Biomedical Research Institute Galicia Sur, Spain.

出版信息

Int J Infect Dis. 2021 Jan;102:554-560. doi: 10.1016/j.ijid.2020.10.097. Epub 2020 Nov 4.

DOI:10.1016/j.ijid.2020.10.097

PMID:33157291

Abstract

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.

摘要

背景

严重感染（如金黄色葡萄球菌菌血症[SAB]）的治疗优化对抗菌药物管理团队来说是一项挑战。目前，SAB 指南建议采用完全静脉治疗（CIT）。

目的

本研究旨在分析金黄色葡萄球菌菌血症（SAB）患者采用口服序贯治疗（OST）的有效性和安全性。

患者和方法

我们在西班牙的一家三级教学医院进行了一项回顾性、观察性研究。纳入标准为复杂性和非复杂性单一致病菌血症以及适当的治疗持续时间，患者分为 OST 或 CIT 组。主要终点为 90 天内 S. aureus 感染复发。我们还分析了死亡率、住院时间和静脉用抗生素治疗时间。

结果

在总共 201 例 SAB 患者中，125 例（62%）接受了 OST。最常使用的口服抗生素是甲氧苄啶-磺胺甲噁唑（66%的患者）。在接受 OST 的患者中，43%患有复杂性菌血症（大多数有骨关节炎感染源），6%有血管内装置。两组 90 天复发率均为 4%，无差异。OST 组的治疗时间（22 [16-28]天与 CIT 组的 13 天 [8-17]；p<0.001）和住院时间（36 [27-71]天与 CIT 组的 18 天 [13-29]；p<0.001）均较短。MRSA 与死亡率相关（OR 4.4，95%CI [1.67-11.37]；p=0.003）。