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Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort

It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performe...

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Detalles Bibliográficos
Autores principales: Castillo-Fernández, Nerea, Pérez-Crespo, Pedro María Martínez, Salamanca-Rivera, Elena, Herrera-Hidalgo, Laura, de Alarcón, Arístides, Navarro-Amuedo, María Dolores, Marrodán Ciordia, Teresa, Pérez-Rodríguez, María Teresa, Sevilla-Blanco, Juan, Jover-Saenz, Alfredo, Fernández-Suárez, Jonathan, Armiñanzas-Castillo, Carlos, Reguera-Iglesias, José María, Natera Kindelán, Clara, Boix-Palop, Lucía, León Jiménez, Eva, Galán-Sánchez, Fátima, del Arco Jiménez, Alfonso, Bahamonde-Carrasco, Alberto, Vinuesa García, David, Smithson Amat, Alejandro, Cuquet Pedragosa, Jordi, Reche Molina, Isabel María, Pérez Camacho, Inés, Merino de Lucas, Esperanza, Gutiérrez-Gutiérrez, Belén, Rodríguez Baño, Jesús, López Cortés, Luis Eduardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854520/
https://www.ncbi.nlm.nih.gov/pubmed/36671330
http://dx.doi.org/10.3390/antibiotics12010129
Descripción
Sumario:It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p < 0.001; OR 0.275, 95%CI 0.129–0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324–1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease.