S aureus bacteremia antibiotics tailored to patient access to treatment

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Provision of oral antibiotics after partial completion of an intravenous regimen for Staphylococcus aureus bacteremia was found in a retrospective cohort study improve outcomes for people who inject drugs (PWID) and are unable to complete 4-6 weeks of standard intravenous therapy.

Investigators point out that S. aureus is the most common pathogen in serious infections in PWID, but that standard treatment with several weeks of intravenous antibiotics, usually completed in an outpatient setting, is often not available for this population. It is also a vulnerable population for other health problems such as hepatitis and HIV.

“PWIDs are often considered ineligible for outpatient parenteral antibiotic therapy and often choose to leave hospital or skilled nursing facilities before undergoing a multi-week course of IV antibiotic therapy as inpatients,” says Laura Marks, MD, PhD, Division of Infectious Diseases, Washington University at St. Louis School of Medicine, St Louis, Missouri, and colleagues.

Marks described the patients for whom their results are most valuable as those likely to struggle to stay in hospital, or who have clear outside responsibilities that preclude the standard intravenous regimen of care (SOC).

“I often see this with patients who might have court dates coming up, or with patients who have left the hospital early many times in the past, or even patients with young children, where they don’t can only leave them with friends or family for so many days,” Marks said Contagion.

“In this cohort, having real-world outcome data to present to patients early on, before I think they might leave, helps me provide them with an informed discussion about the risks and benefits of each antibiotic option, as well as planning the safest time for eventual discharge and ensuring they are closely monitored if they choose to return home on oral antibiotics,” he said. she stated.

Marks and his colleagues compared the results of 3 groups of PWID hospitalized during the period between January 2016 and December 2021 with complications S. aureus bacteraemia, including infective endocarditis, epidural abscess, vertebral osteomyelitis, and septic arthritis: those who received complete intravenous SOC (n=122); an incomplete intravenous course without oral antibiotics at discharge (n=36); and those who switched to oral antibiotics after incomplete SOC (n = 69).

A study already undertaken and published initiative with the latter group to support adherence to the oral antibiotic regimen helped validate treatment status and facilitated this comparison between treatment groups.

“Washington University in St Louis has invested heavily in improving care for PWID with invasive infections and has funded a multidisciplinary team to provide intensive outpatient follow-up, including free visits to the infectious disease clinic and medication for uninsured patients, as well as health coaches and case management,” Marks explained.

Marks and colleagues found that patients who received oral antibiotics after incomplete intravenous therapy were significantly less likely to experience microbiological failure or die than those who were discharged after incomplete intravenous antibiotics without oral antibiotics. There was no significant difference in microbiological failure rates between those who completed SOC and those who received oral antibiotics after completing at least 10 days of intravenous therapy.

Although switching to oral antibiotics was beneficial for the cohort completing at least 10 days of SOC, Marks stressed that it cannot yet be a recommended treatment.

“I do not want these data to be interpreted as approval not to offer these patients SOC therapies, but rather to develop a separate standard of care for patients based solely on a comorbid history of SOC use disorder. substances,” Marks said. “At least until we have more prospective data from randomized controlled trials.”

“If future trials, like the INSTANTANEOUS trial, do not confirm any significant differences, so I think it’s reasonable to assume that in the future we might want to limit the potential complications associated with outpatient parenteral antibiotic therapy, especially for young immunocompetent patients,” said marks.

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