Compliance with Guidelines for Treatment of Staphylococcus aureus Bacteremia is Associated with Decreased Mortality in Patients Hospitalized for Community-Acquired Pneumonia with Staphylococcus aureus Bacteremia

Abstract

Introduction: Staphylococcus aureus bacteremia has a minimum treatment duration of two weeks, while S. aureus community-acquired pneumonia (CAP) treatment is at least five days. Treatment failure, persistent bacteremia, and recurrence are common among patients with community-acquired S. aureus bacteremia. There is conflicting information in the current Infectious Diseases Society of America (IDSA) guidelines for the treatment of S.aureus bacteremia patients with CAP. Therefore, the appropriate treatment duration and modality for S. aureus CAP with bacteremia is unclear. The objective of this study was to compare outcomes among patients with S. aureus CAP and bacteremia treated in compliance versus non-compliance with IDSA S. aureus bacteremia guidelines. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) study database. Logistic regression was used to compare outcomes. Results: A total of 117 patients with S. aureus CAP and bacteremia were included in the study. Compliance with S. aureus bacteremia guidelines was documented in 67 patients, and non-compliance was documented in 50 patients. Compliance with IDSA S. aureus bacteremia guidelines resulted in a decrease in odds of re-hospitalization of 30% after adjusting for confounding variables between the compliant and non-compliant groups (adjusted odds ratio (aOR) 0.70 [95% CI 0.29–1.70]; P=0.42). The 30-day mortality for the compliant group was 6% and for the non-compliant group was 10%; P=0.576. The 1-year mortality for the compliant group was 19% and for the non-compliant group was 44%; P=0.011. Conclusion: The present study demonstrated that when treated in compliance with IDSA guidelines for S. aureus bacteremia, there was decreased 1-year mortality for patients hospitalized for S. aureus CAP with bacteremia. In this case, the IDSA S. aureus bacteremia guidelines recommend treating uncomplicated S. aureus bacteremia with CAP for at least two weeks of antimicrobials and at least four weeks of antimicrobials for complicated S. aureus bacteremia with CAP.