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Review
. 2024 Mar 11:11:20499361241237615.
doi: 10.1177/20499361241237615. eCollection 2024 Jan-Dec.

Short-term versus usual-term antibiotic treatment for uncomplicated Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Santiago Grillo Perez  1   2 , Candida Diaz-Brochero  3   4   5 , Javier Ricardo Garzon Herazo  3   4   5 , Oscar Mauricio Muñoz Velandia  3   4
Affiliations
Review

Short-term versus usual-term antibiotic treatment for uncomplicated Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Santiago Grillo Perez et al. Ther Adv Infect Dis. .

Abstract

Introduction: Uncomplicated Staphylococcus aureus bacteremia remains a leading cause of morbidity and mortality in hospitalized patients. Current guidelines recommend a minimum of 14 days of treatment.

Objective: To evaluate the efficacy and safety of short versus usual antibiotic therapy in adults with uncomplicated S. aureus bacteremia (SAB).

Methods: We developed a search strategy to identify systematic review and meta-analysis of non-randomized studies (NRS), comparing short versus usual or long antibiotic regimens for uncomplicated SAB in MEDLINE, Embase, and the Cochrane Register up to June 2023. The risk of bias was assessed using the ROBINS I tool. The meta-analysis was performed using Review Manager software with a random effect model.

Results: Six NRS with a total of 1700 patients were included. No significant differences were found when comparing short versus prolonged antibiotic therapy as defined by the authors for 90-day mortality [odds ratio (OR): 1.09; 95% confidence interval (CI): 0.82-1.46, p: 0.55; I2 = 0%] or 90-day recurrence or relapse of bacteremia [OR: 0.72; 95% CI: 0.31-1.68, p: 0.45; I2 = 26%]. Sensitivity analysis showed similar results when comparing a predefined duration of <14 days versus ⩾14 days and when excluding the only study with a high risk of bias.

Conclusion: Shorter-duration regimens could be considered as an alternative option for uncomplicated SAB in low-risk cases. However, based on a small number of studies with significant methodological limitations and risk of bias, the benefits and harms of shorter regimens should be analyzed with caution. Randomized clinical trials are needed to determine the best approach regarding the optimal duration of therapy.

Keywords: Staphylococcus aureus; antibiotic duration; bacteremia; meta-analysis; systematic review.

Plain language summary

Comparing short and regular antibiotic treatment duration, for a type of blood infection caused by S. aureus We investigated the optimal duration of antibiotic treatment for adults with a specific type of blood infection (uncomplicated Staphylococcus aureus), a condition with a significant global impact on mortality and costs. After a thorough search, only six trials involving 1700 patients were identified. We therefore decided to perform a meta-analysis (a type of statistical analysis). The results showed that the duration of antibiotics, whether short or long (less or more than 14 days), did not significantly affect mortality or recurrence of infection within 90 days. Consequently, we suggested that shorter courses of antibiotics might be appropriate for less severe cases. However, we emphasized caution because of the limitations of the studies. We recommended further research with improved methods to determine the optimal approach to treating this type of infection.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA flowchart. *NRS, non-randomized studies. **Only the abstract was found.
Figure 2.
Figure 2.
Risk of bias assessment.
Figure 3.
Figure 3.
Forest plot.
See this image and copyright information in PMC

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