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Combination therapy does not decrease 30-day mortality but increases antibiotic consumption in methicillin-sensitive
Özge Özgen-Top1, Pınar Aysert-Yildiz1, Hamid Habibi1
1Department of Infectious Diseases and Clinical Microbiology, Gazi University Medical School, Ankara, Türkiye.
Journal of Chemotherapy (Florence, Italy)
|September 10, 2025
Summary
Combination therapy for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia offers no survival advantage over monotherapy. This approach significantly increases antibiotic consumption (Days of Therapy), suggesting monotherapy is preferable for MSSA infections.
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Antimicrobial Stewardship
Background:
- Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a significant clinical concern.
- Optimal treatment strategies, including monotherapy versus combination therapy, require ongoing evaluation.
Purpose of the Study:
- To compare the efficacy and safety of combination antibiotic therapy against monotherapy for MSSA bacteraemia.
- To assess the impact on mortality, antibiotic consumption (Days of Therapy), and adverse events.
Main Methods:
- Retrospective analysis of adult patients with MSSA bacteraemia from 2018-2023.
- Comparison of monotherapy (beta-lactam alone) versus combination therapy (beta-lactam plus teicoplanin, daptomycin, or linezolid).
- Analysis of 30-day mortality, time to bacterial clearance, and antibiotic consumption using Days of Therapy (DOT).
Main Results:
- No significant difference in 30-day mortality rates between monotherapy (15.1%) and combination therapy (21.4%) groups (P=0.280).
- Time to bacterial clearance was similar between groups (median 4 days).
- Antibiotic consumption (DOT) was significantly higher in the combination therapy group (1420 DOT/1000 patient days) compared to monotherapy (933 DOT/1000 patient days) (P<0.001).
Conclusions:
- Combination therapy for MSSA bacteraemia does not improve survival compared to monotherapy.
- Combination therapy leads to substantially increased antibiotic consumption.
- Routine use of combination therapy for MSSA bacteraemia is not supported by these findings; monotherapy is recommended.
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