Adjunctive β-lactams for Staphylococcus aureus bacteremia: a narrative review

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Staphylococcus aureus bacteremia (SAB) presents a persistent clinical challenge with high mortality rates.
• Evolving SAB epidemiology includes increased community-acquired infections, device use, and metastatic complications.
• Adjunctive beta-lactam therapy is explored to enhance bactericidal activity and improve patient outcomes in SAB.

Purpose of the Study:

• To evaluate the efficacy and safety of adjunctive beta-lactam therapy in managing Staphylococcus aureus bacteremia.
• To explore strategies for optimizing treatment by considering patient heterogeneity and risk stratification.
• To assess the potential of novel frameworks like DOOR and RADAR in evaluating combination therapy for SAB.

Main Methods:

• Review of retrospective studies and randomized controlled trials on adjunctive beta-lactam therapy for SAB.
• Analysis of factors influencing treatment efficacy, including patient characteristics and beta-lactam selection.
• Exploration of patient stratification methods and outcome assessment frameworks (DOOR, RADAR).

Main Results:

• Early evidence suggests improved bacterial clearance with adjunctive beta-lactam therapy.
• Some trials show reduced bacteremia duration, but survival benefits are inconsistent.
• Concerns about acute kidney injury (AKI) exist, though judicious selection may mitigate risks.
• High-risk patients may benefit most from early combination therapy.

Conclusions:

• Optimizing SAB management requires a multifaceted, individualized approach.
• Patient-specific factors, risk stratification, and novel assessment frameworks are crucial.
• Future research should focus on personalized strategies to maximize benefits and minimize adverse events of adjunctive beta-lactam therapy.