Clinical Infection in Practice (Jan 2024)
Impact of shorter (<14 days) antibiotic treatment duration in adults with uncomplicated Staphylococcus aureus bacteremia: A systematic review and meta-analysis
Abstract
Objectives: Staphylococcus aureus is an important cause of bloodstream infections. We aimed to summarize associations between different antibiotic durations (<14 days versus standard durations of ≥ 14 days) and patient outcomes in adult patients with uncomplicated Staphylococcus aureus bacteremia (SAB). Methods: We searched the research literature up to 07/07/2022 for studies with direct comparison of shorter (<14 days) versus standard (≥14 days) antibiotic durations for treatment of SAB against short-term mortality and/or other patient outcomes. Crude odds ratios (ORs) were pooled through fixed and random effects analyses. Sub-group analyses were performed to evaluate differences between older versus more recent studies and between studies addressing selected versus comprehensive patient populations. Results: 3,121 unique references were screened of which six met eligibility criteria. All were observational cohort studies from high-income countries published between 2001 and 2020. No consistent definition of “uncomplicated” SAB was found. In total, 2,150 patients with uncomplicated SAB from 21 hospitals were included; of these 758 (35 %) were treated with < 14 days of antibiotics. Using a fixed-effects meta-analysis, no association was found between treatment duration (<14 days versus ≥ 14 days) and 90-day mortality risk (pooled OR 1.12; 95 %CI 0.86–1.45, p = 0.40) or relapse (pooled OR 2.13; 95 %CI 0.11–42.73, p = 0.62). Sub-group analyses did not reveal any further differences and publication bias seemed unlikely (Egger test p = 0.6). Conclusions: Based on evidence from six observational studies, treating uncomplicated SAB with less than 14 days of antibiotics was not associated with higher 90-day mortality or relapse risk, although the confidence interval for relapse risk was wide and bias and confounding cannot be excluded. Shorter treatment for uncomplicated SAB could therefore be considered as a treatment option. Randomized non-inferiority trials are needed to give a definitive answer to this question.
