Transitioning to oral therapy compared to IV in Staphylococcus aureus bloodstream infections: a systematic review and meta-analysis.

Abstract

Background and objective: Staphylococcus aureus bloodstream infections pose a significant threat to public health and necessitate substantial healthcare resources. The optimal antimicrobial therapy for these infections remains a subject of debate. This systematic review and meta-analysis evaluated the efficacy and safety of early transition to oral antimicrobial therapy compared with continued intravenous (IV) therapy in patients with MRSA and MSSA bloodstream infections.

Method: A PRISMA-guided systematic review and meta-analysis compared the early transition from intravenous to oral antibiotics with continued intravenous therapy in patients with S. aureus infections, utilizing relevant studies from the PubMed, Embase, Scopus, and Web of Science databases from August 2003 to June 2024.

Results: This meta-analysis of 11 studies (N = 54-220, primarily male, age: mid-30s to early 70s) revealed a 71.6% higher risk of all-cause mortality for patients transitioned to early oral therapy than for those who continued IV therapy (RR: 1.716; 95% CI: 1.039-2.836; P = 0.035; I² = 44%). Treatment failure, rehospitalization rates, adverse events, and hospital stay lengths did not differ significantly between groups.

Conclusion: Early oral antimicrobial therapy for S. aureus bloodstream infections significantly reduces mortality compared to prolonged intravenous treatment, without increasing the incidence of adverse events or the risk of rehospitalization, suggesting its safety and efficacy as an alternative therapeutic approach; however, further randomized controlled trials are necessary to corroborate these findings.