Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study

Abstract

Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efficacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.

Clinical Utility of Lefamulin: If Not Now, When?

“…This concept was recently demonstrated in the Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) randomized trial where non-inferiority of PO stepdown was established for bone and joint infections [54]. Clinicians and investigators are becoming more comfortable transitioning patients with uncomplicated S. aureus bloodstream infections to PO regimens [55][56][57]. Regardless, lefamulin bone/joint concentration data and clinical evidence for patients with bloodstream infection are not available.…”

Significant Publications on Infectious Diseases Pharmacotherapy in 2018

“…The most frequently identified organism was Streptococci. Median time to randomization was 17 days in both groups, followed by median treatment durations of 19 days (interquartile range [IQR]: 14-25) and 17 days (IQR: [14][15][16][17][18][19][20][21][22][23][24][25] for the intravenous and oral groups, respectively. Median length of stay (LOS) after randomization was 19 days (IQR: 14-25) and 3 days (IQR: 1-10) for the intravenous and oral groups, respectively (P < .001).…”

“…Clinical and microbiological resolution by day 4 occurred in 68.4% of the piperacillintazobactam group compared with 74.6% of the meropenem group (difference, À6.2%; 95% CI, À15.5% to 3.1%; P ¼ . 19). There were no significant differences observed in other secondary outcomes, including rates of microbiological relapse, secondary infection with another MDR organism, Clostridioides difficile infection, and nonfatal serious adverse events.…”

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

“…In a study of uncomplicated Staphylococcus aureus bacteremia, a similar approach with initial IV therapy and oral linezolid follow-up treatment was noninferior to all-IV treatment. 38 Decisions about the early transition to oral antimicrobials should be made in conjunction with infectious disease specialists where available.…”