Impact of the presence of a prosthetic implant and transition to oral stepdown therapy on relapse rates and mortality in uncomplicated Staphylococcus aureus bacteremia treated with 14 days of antibiotics: a retrospective cohort study
This retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolong...
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| Published in | Microbiology spectrum Vol. 13; no. 7; p. e0333724 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Society for Microbiology
01.07.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2165-0497 2165-0497 |
| DOI | 10.1128/spectrum.03337-24 |
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| Abstract | This retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. |
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| AbstractList | The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated Staphylococcus aureus bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9-144.0]) and OST (OR 0.7 [95% CI 0.1-6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5-3.7]) and OST (aOR 0.5 [95% CI 0.2-1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI.IMPORTANCEThis retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject.The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated Staphylococcus aureus bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9-144.0]) and OST (OR 0.7 [95% CI 0.1-6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5-3.7]) and OST (aOR 0.5 [95% CI 0.2-1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI.IMPORTANCEThis retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9-144.0]) and OST (OR 0.7 [95% CI 0.1-6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5-3.7]) and OST (aOR 0.5 [95% CI 0.2-1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI.IMPORTANCEThis retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. ABSTRACT The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated Staphylococcus aureus bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9–144.0]) and OST (OR 0.7 [95% CI 0.1–6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5–3.7]) and OST (aOR 0.5 [95% CI 0.2–1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI.IMPORTANCEThis retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated Staphylococcus aureus bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9–144.0]) and OST (OR 0.7 [95% CI 0.1–6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5–3.7]) and OST (aOR 0.5 [95% CI 0.2–1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI.IMPORTANCEThis retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. This retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing antimicrobial resistance worldwide, these retrospective findings support the perspective that not all PIs are systematically infected. Prolonged antibiotic therapy may therefore not be routinely needed if infection is excluded and thorough evaluation for dissemination performed, accompanied by close clinical and biological monitoring. Early transition to oral therapy in this context, which has been implemented in our institution for years, does not appear to be associated with a higher risk of therapeutic failure. These findings align with the most recent literature on the subject. The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from intravenous to oral antibiotics (oral stepdown therapy [OST]) on the risk of relapse in patients with otherwise uncomplicated Staphylococcus aureus bacteremia (SAB) treated with antibiotics for 14 days. The primary outcome was the 90-day SAB relapse rate in patients with and without a PI. Secondary outcomes were 90-day mortality among patients with or without a PI and 90-day SAB relapse and mortality in patients who had OST. We included 188 consecutive patients with SAB without metastatic foci and with a planned antibiotic treatment duration of 14 days: 58 (31%) had a presumed uninfected PI, and 108 (57%) had OST. Four patients (2%) relapsed, and 25 patients (13%) died. Patients with a PI were more likely to have diagnostic tests performed. In the univariate analysis, the presence of a PI (odds ratio [OR] 7 [95% confidence interval {CI} 0.9–144.0]) and OST (OR 0.7 [95% CI 0.1–6.2]) were not associated with 90-day relapse. In the multivariable analysis, the presence of a PI (adjusted odds ratio [aOR] 1.3 [95% CI 0.5–3.7]) and OST (aOR 0.5 [95% CI 0.2–1.4]) were not predictive of 90-day mortality. In a setting where full diagnostic workup and close follow-up can be ensured, the presence of a PI and OST did not seem to be associated with an increase in 90-day mortality in patients with otherwise uncomplicated SAB. Although the relapse rate was low overall, there was a non-significant trend toward a higher risk of relapse in patients with a PI. |
| Author | Barnier, Jean-Philippe Blez, Damien Mainardi, Jean-Luc Labarbe, Luc Grohs, Patrick Lebeaux, David Dubert, Marie |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40407372$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/j.jinf.2018.08.015 10.1093/cid/ciaa801 10.1016/j.amjmed.2021.10.007 10.1016/j.cmi.2022.03.025 10.1086/318704 10.1016/j.amjmed.2005.06.011 10.1016/S1473-3099(23)00756-9 10.1093/cid/ciy1144 10.1097/01.md.0000091184.93122.09 10.1016/S0140-6736(22)02185-7 10.1093/eurheartj/ehv319 10.1093/cid/ciac714 10.1086/314712 10.1016/j.amjmed.2015.09.006 10.1093/ofid/ofaa151 10.1016/j.cmi.2021.10.022 10.1093/cid/ciad666 10.1016/j.jinf.2011.05.005 10.1016/j.ijid.2020.10.097 10.1093/ofid/ofac207 10.1093/cid/ciq146 10.1128/jcm.30.3.670-674.1992 10.1093/cid/ciad363 10.1016/j.cmi.2023.02.001 10.48101/ujms.v126.5653 10.1056/NEJMoa1808312 10.1093/cid/civ120 10.1093/ofid/ofz170 10.1128/CMR.00134-14 10.1016/j.hrthm.2020.12.011 |
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| Keywords | device oral stepdown therapy prosthesis short-course antibiotic therapy Staphylocococcus aureus |
| Language | English |
| License | This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license. https://creativecommons.org/licenses/by/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 J.-L.M. is a member of the scientific committee of the BioAster Company and has participated in advisory boards with MSD Merck Sharp & Dohme AG. |
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| Snippet | This retrospective study provides reassuring real-world data supporting a short 14-day treatment course for SAB in patients with PIs. In an era of increasing... The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from... ABSTRACT The aim of this single-center, retrospective observational study was to evaluate the effects of having a prosthetic implant (PI) and of changing from... |
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| SubjectTerms | Administration, Oral Adult Aged Aged, 80 and over Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Antimicrobial Chemotherapy Bacteremia - drug therapy Bacteremia - microbiology Bacteremia - mortality device Female Humans Male Middle Aged oral stepdown therapy Prostheses and Implants - microbiology prosthesis Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - mortality Recurrence Research Article Retrospective Studies short-course antibiotic therapy Staphylococcal Infections - drug therapy Staphylococcal Infections - microbiology Staphylococcal Infections - mortality Staphylococcus aureus - drug effects Staphylocococcus aureus Treatment Outcome |
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| Title | Impact of the presence of a prosthetic implant and transition to oral stepdown therapy on relapse rates and mortality in uncomplicated Staphylococcus aureus bacteremia treated with 14 days of antibiotics: a retrospective cohort study |
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