Combination therapy does not decrease 30-day mortality but increases antibiotic consumption in methicillin-sensitive S. aureus bacteraemia.

IF 1.8 4区医学 Q3 INFECTIOUS DISEASES

Journal of Chemotherapy Pub Date : 2025-09-10 DOI:10.1080/1120009X.2025.2556578

Özge Özgen-Top, Pınar Aysert-Yildiz, Hamid Habibi, İbrahim Orhun Hatipoğlu, Elif Ayça Şahin, Zeynep Tekin Taş, Hasan Selçuk Özger, Murat Dizbay

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引用次数: 0

Abstract

Purpose: The study aimed to compare the impact of combination and monotherapy on mortality, antibiotic consumption using 'Days of Therapy (DOT)', and antibiotic-related adverse events in patients with methicillin-susceptible S. aureus (MSSA) bacteraemia.

Methods: This retrospective study included all adult patients (>18 years) with MSSA bacteraemia who received either monotherapy (beta-lactam alone) or combination therapy (beta-lactam plus teicoplanin or daptomycin or linezolid) between 2018 and 2023. Mortality, antibiotic consumption, and factors predicting mortality were analysed. Groups were compared for 30-d mortality with survival analysis. Logistic regression models were used to identify risk factors for mortality. Antibiotic consumption was calculated by DOT.

Results: Among 395 patients screened, 185 patients who had an MSSA bacteraemia received either monotherapy (n = 73, 39.5%) or combination therapy (n = 112, 60.5%). The 30-d mortality rate was similar between groups (%15.1 vs. 21.4, P = 0.280). Time to bacterial clearance was also similar (median (IQR): 4 (3-7) vs. 4 (3-7) d, P = 0.699). DOT per 1000 patient days was significantly higher in the combination therapy group than in the monotherapy group (median, IQR: 1420, 827-1836 vs. 933, 732-1000), P < 0.001). The 30-d mortality rate was 18.9% (n = 35/185), and the PITT bacteraemia score was the only independent predictor of mortality (median, IQR: 1506, 1.264-1.794, P < 0.001).

Conclusions: Our findings indicate that combination therapy does not confer a survival benefit over monotherapy in patients with MSSA bacteraemia. However, combination therapy was associated with a significant increase in antibiotic consumption. Therefore, our results do not support the routine use of combination therapy for MSSA bacteraemia in this patient population.

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联合治疗不能降低30天死亡率，但会增加甲氧西林敏感金黄色葡萄球菌菌血症的抗生素用量。

目的：该研究旨在比较联合治疗和单一治疗对甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症患者死亡率、抗生素使用天数（DOT）和抗生素相关不良事件的影响。方法：本回顾性研究纳入了2018年至2023年间接受单药治疗（β -内酰胺单独）或联合治疗（β -内酰胺加替柯planin或达托霉素或利奈唑胺）的所有MSSA菌血症成年患者（bb0 - 18岁）。分析死亡率、抗生素用量和预测死亡率的因素。比较各组30 d死亡率和生存分析。Logistic回归模型用于确定死亡率的危险因素。抗生素用量由DOT计算。结果：在筛选的395例患者中，185例MSSA菌血症患者接受了单药治疗（n = 73, 39.5%）或联合治疗（n = 112, 60.5%）。组间30 d死亡率相似（%15.1 vs. 21.4, P = 0.280）。细菌清除的时间也相似（中位数（IQR）： 4（3-7）对4 (3-7)d, P = 0.699）。联合治疗组每1000患者日的DOT显著高于单药治疗组（中位数，IQR: 1420,827 -1836 vs. 933,732 -1000）， P n = 35/185)， PITT菌血症评分是死亡率的唯一独立预测因子（中位数，IQR: 1506, 1.264-1.794， P）结论：我们的研究结果表明，在MSSA菌血症患者中，联合治疗并不比单药治疗带来生存优势。然而，联合治疗与抗生素用量的显著增加有关。因此，我们的结果不支持在该患者群体中常规使用联合治疗MSSA菌血症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Chemotherapy 医学-药学

CiteScore

3.70

自引率

0.00%

发文量

144

审稿时长

6-12 weeks

期刊介绍： The Journal of Chemotherapy is an international multidisciplinary journal committed to the rapid publication of high quality, peer-reviewed, original research on all aspects of antimicrobial and antitumor chemotherapy. The Journal publishes original experimental and clinical research articles, state-of-the-art reviews, brief communications and letters on all aspects of chemotherapy, providing coverage of the pathogenesis, diagnosis, treatment, and control of infection, as well as the use of anticancer and immunomodulating drugs. Specific areas of focus include, but are not limited to: · Antibacterial, antiviral, antifungal, antiparasitic, and antiprotozoal agents; · Anticancer classical and targeted chemotherapeutic agents, biological agents, hormonal drugs, immunomodulatory drugs, cell therapy and gene therapy; · Pharmacokinetic and pharmacodynamic properties of antimicrobial and anticancer agents; · The efficacy, safety and toxicology profiles of antimicrobial and anticancer drugs; · Drug interactions in single or combined applications; · Drug resistance to antimicrobial and anticancer drugs; · Research and development of novel antimicrobial and anticancer drugs, including preclinical, translational and clinical research; · Biomarkers of sensitivity and/or resistance for antimicrobial and anticancer drugs; · Pharmacogenetics and pharmacogenomics; · Precision medicine in infectious disease therapy and in cancer therapy; · Pharmacoeconomics of antimicrobial and anticancer therapies and the implications to patients, health services, and the pharmaceutical industry.