Table.
Studies reporting on duration of therapy in patients with Staphylococcus aureus bacteremia
| Study | Design | Sample size | Results | Conclusions |
|---|---|---|---|---|
| Holland 2018 (6) | Randomized controlled trial | 116 patients with SAB | Unsuspected complicated SAB occurred in 32%
when diagnostic algorithm used Clinical success achieved in 73% patients with Uncomplicated SAB |
Study was inadequately powered for SAB
endpoint. DOT 2 weeks should be used with caution and only if patients have undergone rigorous evaluation for metastatic infection. |
| Jernigan 1993 (15) | Meta-analysis of 11 studies | 132 patients with uncomplicated catheter-related SAB who were treated with short course therapy | Complication rate in patients with catheter
related SAB was 25% Mortality rate for catheter-related SAB was 15% |
DOT >2 weeks should be used until a prospective study is available |
| Chong 2013 (16) | Prospective cohort | 111 patients with uncomplicated SAB | DOT <14 days was significantly
associated with relapse 7.9% versus 0% in DOT ≥14 days;
(p=0.036). Crude mortality in patients with DOT <14 was not statistically different than DOT ≥14 (18.4% vs 21.9%, p=0.67) |
Even with a low risk of complication, SAB without a known source should be treated for ≥14 days |
| Rahal 1986 (17) | Randomized controlled trial | 84 patients with SAB; 32 patients completed treatment | 31.3% of patients with SAB without endocarditis who treated with 2 weeks of antibiotics were cured. | Study was inadequately powered to draw
conclusions regarding optimal duration of therapy. Unable to reliably detect complications in patients treated for only 2 weeks |
| Iannini 1976 (18) | Retrospective cohort | 29 patients with SAB associated with removable source of infection | Patients with SAB received median DOT 15.2 days: no relapses | 10 to 21 days of patients may be sufficient for catheter associated SAB as long as focus of bacteremia is removed |
| Ehni 1989 (19) | Prospective observational | 13 patients with catheter associated SAB | 7.7% Relapse rate in patients treated with <17 days of therapy | DOT <17 days for catheter associated SAB with close follow up may be safe |
| Raad 1992 (20) | Retrospective cohort | 55 patients with catheter-associated SAB | 16% vs 0% patients SAB treated for <10 days vs ≥ 10 days relapsed, respectively (p= 0.05). | DOT should not be < 10 days but may be
≤ 14 days. Fever and/or bacteremia that persists for ≥ 3 days after catheter removal and initiation of antibiotics should require prolonged treatment |
| Mylotte 1987 (21) | Prospective observational | 28 patients with catheter associated SAB | 82% of patients who recovered received ≤2 weeks of therapy | Catheter associated SAB may be treated for no more than 14 days if catheter is removed. |
| Malanoski 1995 (22) | Retrospective cohort | 102 patients with SAB; 55 of those patients had catheter-associated SAB | Relapse rates in patients treated 10 –
15 days was 0% vs 4.7% in those treated > 15
days Late complications were associated with DOT <10 days |
DOT of 10–15 days may be safe in cases
of catheter associated SAB provided the Infected catheters is promptly
removed DOT for SAB should not be shortened to <10 days |
| Zeylemaker 2001 (23) | Retrospective cohort | 49 patients with catheter-associated SAB | Attributable death was 31% in DOT <14 days vs 20% in longer DOT. | DOT should not be shortened to <14 days |
| Jensen 2002 (24) | Prospective observational | 278 patients with SAB | DOT <14 was significantly associated
with mortality (OR, 0.84; 95% CI,
0.76–0.94) Overall mortality 34% |
DOT for SAB should be > 14
days. Removal of infected focus of infection is integral to the outcome of SAB |
| Pigrau 2003 (25) | Retrospective cohort | 87 patients with SAB; 64 with uncomplicated SAB | 62/64 patients with uncomplicated SAB who were treated with 10–14 days were followed for 3 months: none relapsed. | DOT 10–14 days for uncomplicated catheter associated SAB may be sufficient |
| Fatkenheuer 2004 (26) | Retrospective cohort | 229 patients with SAB | DOT <14 days had no difference in survival compared to ≥ 14 days | DOT <14 days may be sufficient for SAB
but should be interpreted with caution Guidelines for management of SAB are not routinely followed in practice and failure to do so may negatively affect mortality and outcomes |
| Thomas 2005 (27) | Prospective observational | 276 with catheter associated SAB | No association between DOT and rate of
relapse DOT ≤ 14 days was not associated with increased risk of relapse as compared to longer DOT |
In patients who have favorable response to catheter removal and initial treatment, DOT <14 days may be sufficient |
| Kreisel 2006 (28) | Retrospective cohort | 397 patients with SAB | No association between DOT ≤14 days and risk for recurrence (RR, 0.68; 95% CI, 0.44–1.04) | A DOT ≤ 14 days may be sufficient for
uncomplicated SAB Patients with diabetes, HIV or with MRSA infections are at an increased risk for recurrence and should be followed closely |
| Ghanem 2007 (29) | Retrospective cohort | 91 cancer patients with SAB | DOT <14 days is associated with increased complications in patients with malignancy | Caution should be used in treating patients with malignancy for ≤14 days |
DOT, duration of therapy; SAB, Staphylococcus aureus bacteremia