Platts Stephen, Payne Brendan A I, Price D Ashley, Pareja-Cebrian Lucia, Schwab Ulrich
Medical School, Newcastle University, Newcastle-upon-Tyne, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Clin Infect Pract. 2022 Nov;16:100202. doi: 10.1016/j.clinpr.2022.100202.
Long courses of intravenous antimicrobial therapy are traditionally recommended for the treatment of methicillin sensitive bacteraemia (MS-SAB), but are not always completed in clinical practice. Early intravenous to oral antibiotic switch is a key component of antimicrobial stewardship. This study aimed to identify whether intravenous antibiotic duration may be safely reduced in MS-SAB.
We performed a single-centre retrospective study of MS-SAB management. Successful outcome was defined as 90-day recurrence-free survival. Effect of intravenous antibiotic duration on 90-day recurrence risk was examined.
281 adult cases of MS-SAB were evaluated, of which 208 (74%) had a successful outcome. 176 cases (63%) received less than 14 days of intravenous antimicrobial therapy. Very short durations of intravenous therapy were associated with increased risk of recurrence (<7 days iv, 9.8% recurrence; 7-13 days, 1.4%; ≥14 days, 2.9%; p 0.005). This effect was robust to sensitivity analysis for total antimicrobial therapy duration of 14 days. CRP reduction of at least 37% from peak value at intravenous to oral antibiotic switch was associated with decreased risk of recurrence (<37% CRP reduction, 12% recurrence; >37%, 2.0%; p 0.001).
Oral antimicrobial switch may allow safe reductions in duration of intravenous therapy in MS-SAB.
传统上推荐采用长疗程静脉抗菌治疗来治疗甲氧西林敏感菌血症（MS-SAB），但在临床实践中并非总能完成整个疗程。早期静脉转口服抗生素治疗是抗菌药物管理的关键组成部分。本研究旨在确定MS-SAB患者的静脉抗生素治疗疗程是否可以安全缩短。
我们对MS-SAB的管理进行了一项单中心回顾性研究。成功结局定义为90天无复发存活。研究了静脉抗生素治疗疗程对90天复发风险的影响。
评估了281例成年MS-SAB病例，其中208例（74%）获得成功结局。176例（63%）接受了少于14天的静脉抗菌治疗。静脉治疗疗程过短与复发风险增加相关（静脉治疗<7天，复发率9.8%；7-13天，1.4%；≥14天，2.9%；p<0.005）。对于总抗菌治疗疗程为14天的敏感性分析，该效应仍然显著。静脉转口服抗生素治疗时，C反应蛋白（CRP）从峰值至少降低37%与复发风险降低相关（CRP降低<37%，复发率12%；>37%，2.0%；p<0.001）。
口服抗菌药物转换治疗可能允许安全缩短MS-SAB患者的静脉治疗疗程。
