[Staphylococcus aureus bacteremia: the long road to adequate therapy : Recent studies]

Staphylococcus aureus bacteremia (SAB) is a heterogeneous and difficult-to-treat disease with a high mortality rate.

Presentation of the challenges of randomized controlled trials (RCTs) on SAB, and an overview of the current state of research and future studies.

Search for RCTs on SAB in PubMed and clinicaltrials.gov over the past 20 years.

The design and implementation of RCTs on SAB is complex. Current RCTs incorporate new developments such as pragmatic study design, adaptive platform studies, endpoints with a desirability of outcome ranking (DOOR) and enrichment of clinical phenotypes. The latest results regarding therapy show that cefazolin is not inferior to flucloxacillin in the treatment of methicillin-susceptible S. aureus (MSSA)-SAB and is less nephrotoxic. There is no general recommendation for combination therapy. In low-risk SAB, early oral switch therapy is possible after 5-7 days.

RCTs on SAB therapy require careful planning and inclusion of subgroups. Further RCTs are necessary to optimize therapy.