Dr. Toy
Clinical question: Is an early switch to oral antimicrobial therapy in low-risk Staphylococcus aureus bloodstream infection non-inferior to standard intravenous antimicrobial therapy?
Background: S aureus bloodstream infections are typically treated with at least 14 days of intravenous antimicrobials. A switch to oral antimicrobial therapy may reduce hospital length of stay and infusion-related complications.
Study design: International, open-label, randomized, controlled, non-inferiority trial
Setting: 31 tertiary care hospitals in Germany, France, Netherlands, and Spain
Synopsis: 213 patients were randomized to switch to oral therapy after five to seven days of intravenous antimicrobial therapy (n=108) or continue intravenous therapy (n=105). Patients with complicated bloodstream infections (such as deep-seated infections affecting another organ, like empyema and endocarditis), non-removable foreign devices, severe comorbidity, or injection drug users were excluded. The primary endpoint was the occurrence of any complication related to S aureus bloodstream infection, such as relapsing bloodstream infection, deep-seated infection, and mortality attributable to infection within 90 days. In the oral switch group, 13% (n=14) met the primary endpoint versus 12% (n=13) in the intravenous group. Hospital length of stay after the first positive blood culture was shorter in the oral switch group with a median of 12 days versus 16 days in the intravenous group. The incidence of Clostridioides difficile infection was similar. Limitations of this trial included: challenges associated with assigning patients to the low-risk category, few participants with methicillin-resistant S aureus infection (n=16), and slow recruitment that led to early trial termination and performance of interim analysis.
Bottom line: For low-risk patients with S aureus bloodstream infection, switching to oral antimicrobial therapy after five to seven days of intravenous antimicrobial therapy was non-inferior to the standard 14 days of intravenous therapy.
Citation: Kaasch AJ, López-Cortés LE, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis. 2024:S1473-3099(23)00756-9.
Dr. Toy is a faculty physician in the division of hospital medicine at the University of California in San Diego.