Uncomplicated S. aureus Bacteremia Needs 14 Days of Treatment
By Will Boggs, MD
NEW YORK (Reuters Health) Jan 02 - Uncomplicated Staphylococcus aureus bacteremia should be treated for at least 14 days to prevent relapse, Korean researchers say.
That matches the recommendation of the Infectious Diseases Society of America (IDSA) - but the researchers say that guideline was never formally evaluated in clinical studies.
The new study by Dr. Yang Soo Kim and colleagues from the University of Ulsan College of Medicine, Seoul, Korea involved 111 patients with uncomplicated S. aureus bacteremia.
Nearly half (53, 47.7%) had methicillin-resistant S. aureus (MRSA). Only two patients (1.8%) had community-acquired bacteremia, according to a report online December 17th in Antimicrobial Agents and Chemotherapy.
Patients received standard doses of antibiotics for S. aureus bacteremia, the authors said. Fifty-five of 58 patients with methicillin-susceptible S. aureus bacteremia received cefazolin (48.3%) or nafcillin (46.6%); the other three received vancomycin. Most patients with MRSA bacteremia (85%) received vancomycin; the others received teicoplanin or linezolid.
The combined rate of relapse and death was similar in patients treated for fewer than 14 days or for at least 14 days (26.3% vs 21.9%).
But relapse occurred only in patients treated for less than 14 days (p=0.036).
The only factor independently associated with treatment failure was a high Charlson comorbidity score, however. Duration of antibiotic therapy was not significantly associated with treatment failure in multivariate analysis.
"The relapse rate after short-course therapy for uncomplicated S. aureus bacteremia should be close to zero," the researchers say. "Therefore, the relapse rate of 7.9% in our study (with short course therapy) is not acceptable, and it seems reasonable that uncomplicated S. aureus bacteremia should be treated for at least 14 days."
"Because of increased risk for treatment failure," they add, "patients with a high Charlson comorbidity score or primary bacteremia, especially if it is community-acquired, should not be treated with short-course therapy."
"These recommendations need to be further evaluated in a large multicenter study," the researchers caution
Dr. Richard G. Wunderink, a pulmonary critical care physician Northwestern University in Chicago, told Reuters Health, "The issue with Staph bacteremia is that the source is often unknown and potentially uncontrolled. So some of these patients may have either occult endocarditis or some other form of endovascular infection."
"The other factor is that vancomycin is just not a very effective antibiotic," Dr. Wunderink said. "Whether longer treatment is needed with more bactericidal antibiotics such as daptomycin or ceftaroline for these uncomplicated bacteremia cases is still unknown."
"So the bottom line, from the standpoint of a Pulmonary/Critical Care physician with a strong bias against prolonged antibiotic courses, is that this study supports the current recommendation, and I don't see a compelling reason to change the recommendation," Dr. Wunderink concluded.
Dr. Kim did not respond to a request for comments on this report.
Antimicrob Agents Chemother 2012.
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