Long versus short course anti-MICROBIAL therapy of uncomplicated STAPHYLOCOCCUS aureus bacteraemia: a systematic review

Martin Schnizer, Paul Schellong, Norman Rose, Carolin Fleischmann-Struzek, Stefan Hagel, Mohamed Abbas, Brendan Payne, Rebecca N Evans, Mathias W. Pletz, Sebastian Weis*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background
Current guidelines recommend at least two weeks duration of antibiotic therapy (DOT) for patients with uncomplicated Staphylococcus aureus bacteraemia (SAB) but the evidence for this recommendation is unclear.

Objectives
To perform a systematic literature review assessing current evidence for recommended DOT for patients with SAB.

Methods
Data sources: We searched MEDLINE, ISI Web of Science, the Cochrane Database and clinicaltrials.gov from inception to March 30, 2024. References of eligible studies were screened and experts in the field contacted for additional articles.

Study eligibility criteria
All clinical studies, regardless of design, publication status and language.

Participants
Adult patients with uncomplicated SAB.

Interventions
Long (>14; >18; 11-16 days) vs. short (≤14; 10-18; 6-10 days, respectively) DOT with the DOT being defined as the first until the last day of antibiotic therapy.

Assessment of risk of bias
Risk of bias was assessed using the ROBINS-I-tool.

Methods of data synthesis
The primary outcome was 90-day all-cause mortality. Only studies presenting results of adjusted analyses for mortality were included. Data synthesis could not be performed.

Results
Eleven non-randomized studies were identified that fulfilled the predefined inclusion criteria, of which three studies reported adjusted effect ratios. Only these were included in the final analysis. We did not find any RCT. Two studies with 1,230 patients reported the primary endpoint 90-day all-cause mortality. Neither found a statistically significant superiority for longer (>14; 11-16 days) or shorter DOT (≤14; 6-10 days, respectively) for patients with uncomplicated SAB. Two studies investigated the secondary endpoint 30-day all-cause mortality (>18; 11-16 days vs. 10-18; 6-10 days, respectively) and did not find a statistically significant difference. All included studies had a moderate risk of bias.

Conclusions
Sound evidence that supports any duration of antibiotic treatment for patients with uncomplicated SAB is lacking.
Original languageEnglish
JournalClinical Microbiology and Infection
Early online date29 May 2024
DOIs
Publication statusE-pub ahead of print - 29 May 2024

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