Oral Therapy for Low-Risk Staphylococcus aureus Bloodstream Infections: Can Staph aureus be “uncomplicated”?

Reviewed by Sara Karaba, MD, PhD, MHS, Johns Hopkins University

The SABATO trial is an open-label, randomized, controlled, non-inferiority trial comparing IV vs early oral switch therapy for uncomplicated (low-risk) S. aureus bacteremia (SAB). All patients received 5-7 days of IV therapy and then were randomly assigned to either standard IV therapy or early oral switch therapy for a total treatment duration of 14 days. In the oral switch group 13% (14/108) of participants reached the primary composite end point (complications related to SAB within 90 days or death attributable to SAB) vs 12% (13/105) in the IV group with a treatment difference of 0.7 (95% CI -7.8-9.1). Patients in the IV group did have longer lengths of hospital stay following SAB (median 16 vs 12 days in oral switch group). This study suggests that switching to oral therapy for the treatment of SAB had non-inferior clinical outcomes among those with uncomplicated/low-risk SAB. However, this study also illustrates that uncomplicated SAB is uncommon, as only 4.2% (213/5063) of participants who were assessed were enrolled, and the study was stopped early due to slow recruitment of eligible participants.

Reference: Kaasch AJ, López-Cortés LE, Rodríguez-Baño J, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis 2024; :S1473-3099(23)00756–9. doi: 10.1016/S1473-3099(23)00756-9.

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