Why the study?
It was unclear whether an extended course of antimicrobial therapy is necessary in low-risk Staphylococcus aureus bloodstream infection in patients with clinically uninfected foreign bodies such as pacemakers/AICDs or orthopedic implants.
Does the presence of clinically uninfected foreign bodies (pacemakers/AICDs or orthopedic implants) affect outcomes or require extended antimicrobial therapy in patients with low-risk Staphylococcus aureus bloodstream infection?
Does the presence of clinically uninfected foreign bodies (pacemakers/AICDs or orthopedic implants) affect outcomes or require extended antimicrobial therapy in patients with low-risk Staphylococcus aureus bloodstream infection?
In low-risk Staphylococcus aureus bloodstream infection, the presence of clinically uninfected foreign bodies like pacemakers or orthopedic implants did not significantly impact mortality or SAB-related events at 1 year, suggesting standard treatment duration may be sufficient.
Answers are grounded in this paper and cite their sources.
Standard therapy duration may suffice for low-risk SAB with uninfected foreign bodies; leaves open need for randomized confirmation.
Background The standard treatment duration in low-risk Staphylococcus aureus bloodstream (SAB) is 14 days. However, it is unclear whether an extended course of antimicrobial therapy is necessary in patients with clinically uninfected prosthetic joints/osteosyntheses or pacemakers/automated implanted cardioverter-defibrillators (AICDs). Thus, we compared the duration of antimicrobial therapy and outcomes in patients with and those without clinically uninfected foreign bodies. Methods We conducted a post hoc analysis of data from the prospective Invasive Staphylococcus aureus Infection Cohort (INSTINCT) study. Adult low-risk patients who survived ≥4 days were assessed for duration of treatment, SAB-related events (attributable death, relapse, or new deep-seated infection), and survival. Results Of the 1288 patients enrolled, 292 satisfied criteria for low-risk SAB. Forty-three patients (15%) had a clinically uninfected pacemaker/AICD or orthopedic implant. Patients with foreign bodies were significantly older (mean age, 72 vs 62 years for those without; P < .001; P = .9) and had a higher Charlson score (median, 3 vs 2; P = .06). The total duration of antimicrobial therapy (median, 18 vs 17 days, respectively; P = .7), all-cause mortality rate (16% vs 14%; P = .7), and prevalence of SAB-related events within 90 days were similar (2% vs 2%) in the 2 groups. At 1-year follow-up, SAB-related events were more frequent in patients with foreign bodies (7% vs 4% in those without; P = .4) (hazard ratio, 1.41; 95% confidence interval, .35–5.69; in a multivariable Cox model), but this difference was not statistically significant. Conclusions Low-risk patients with clinically uninfected foreign bodies received a similar duration of antimicrobial therapy without a significant impact on mortality rate. The observed higher hazard ratio of SAB-related events within 1 year necessitates additional studies before recommendations concerning treatment duration in this patient subgroup can be adapted or modified.
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Kaasch et al. (2019) studied this question.
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