Oral Antimicrobial Therapy: Efficacy and Safety for Methicillin-Resistant Staphylococcus aureus Infections and Its Impact on the Length of Hospital Stay
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Background: Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths ofhospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinicalefficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as theinitial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA)infection. Materials and Methods: A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea fromJanuary to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptibleto clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortalityand switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the twotreatment groups. Results: During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participatinghospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). Themedian Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000),and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different betweenthe case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones(n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-relatedadverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length ofhospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (in-terquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was notan independent risk factor for treatment failure. The statistically significant factors associated with treatment failure includedunderlying hepatic diseases, prior receipt of antibiotics, and foreign body retention. Conclusions: This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as theinitial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
Abstract
Background: Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths ofhospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinicalefficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as theinitial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA)infection. Materials and Methods: A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea fromJanuary to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptibleto clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortalityand switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the twotreatment groups. Results: During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participatinghospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). Themedian Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000),and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different betweenthe case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones(n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-relatedadverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length ofhospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (in-terquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was notan independent risk factor for treatment failure. The statistically significant factors associated with treatment failure includedunderlying hepatic diseases, prior receipt of antibiotics, and foreign body retention. Conclusions: This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as theinitial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
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