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Oral switch therapy for paediatric Staphylococcus aureus bloodstream infections: A retrospective study in a tertiary
Federica Attaianese1, Johan Benhard1, Jérémie F Cohen1
1Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France.
Insights
Early oral antibiotic switch is a safe alternative to prolonged intravenous therapy for pediatric Staphylococcus aureus bloodstream infections (SAB). This strategy significantly reduced hospital stays with comparable failure rates, warranting further investigation.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Prolonged intravenous (IV) antibiotic therapy is the standard for Staphylococcus aureus bloodstream infections (SAB).
- Early oral switch strategies may provide a safe and effective alternative in pediatric cases.
- Evaluating the feasibility and outcomes of oral switch in children with SAB is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of an early oral switch strategy for pediatric Staphylococcus aureus bloodstream infections (SAB).
- To compare outcomes between patients receiving standard IV therapy and those switched to oral antibiotics.
- To assess the impact on hospital stay duration and treatment failure rates.
Main Methods:
- Retrospective review of pediatric SAB cases (June 2021-December 2023) at a tertiary hospital.
- Identification of S. aureus-positive blood cultures via microbiological informatics systems.
- Comparison of patient and infection characteristics between full IV and oral switch groups.
Main Results:
- Over half (58.6%) of 140 pediatric SAB cases utilized an oral switch strategy.
- The oral switch group had a significantly shorter median hospital stay (13 days vs. 48 days; p=0.03).
- Thirty-day failure rates were comparable between oral switch (2.4%) and full IV (3.4%) groups (p=0.86).
Conclusions:
- Early oral switch is a viable and safe alternative for over half of pediatric SAB cases.
- This strategy offers significant benefits, including reduced hospital length of stay.
- Further prospective studies are recommended to confirm these findings and guide broader implementation.
Objectives:
Prolonged intravenous (IV) antibiotic therapy remains standard for Staphylococcus aureus bloodstream infections (SAB). However, early oral switch may offer a safe alternative. We evaluated the oral switch strategy in children with SAB.
Methods:
All pediatric SAB cases managed at a tertiary hospital between June 2021 and December 2023 were identified by reviewing S. aureus-positive blood cultures through microbiological informatics systems. Characteristics of patients and infectious episodes were compared between the standard full-IV treatment and the oral switch strategy.
Results:
Among 140 cases, 82 (58.6%) were managed with an oral switch strategy. Bone and joint infections accounted for most oral switch cases (40.2%), while central line-associated bloodstream infections predominated in the full-IV group (86.2%). All endocarditis (n = 2) and 4/10 suppurative thrombophlebitis cases underwent oral switch. Median hospital stay was significantly shorter in the oral switch group (13 days [IQR, 8-24.7] vs 48 days [IQR, 24-78.2]; P = 0.03). Thirty-day failure rates were comparable between oral switch (2/82, 2.4%) and full-IV (2/58, 3.4%) groups (adjusted risk difference 0.5%, 95% CI, -5.4 to 6.4, P = 0.86).
Conclusion:
Oral switch, used in over half of children with SAB, may offer a safe alternative to full IV therapy. Broader prospective studies are warranted to confirm these findings.
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