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Kengo Inagaki, Jose Lucar, Chad Blackshear, Charlotte V Hobbs, Reply to McGuire, et al, Clinical Infectious Diseases, Volume 71, Issue 10, 15 November 2020, Page 2767, https://doi.org/10.1093/cid/ciaa110
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TO THE EDITOR—We appreciate the letter from McGuire et al [1]. for their insightful comments on our study. We agree with the authors that adequate treatment of Staphylococcus aureus bacteremia including sufficient duration of antibiotic therapy, infectious disease specialist consultation, and source control would be important factors to consider in improving outcomes based on prior studies.
S. aureus bacteremia has traditionally been treated with 4–6 weeks of parenteral antibiotic therapy unless criteria for uncomplicated bacteremia are met [2], when shorter courses of antibiotic therapy can be acceptable, although no less than 2 weeks of therapy is recommended. Indeed, short-course antibiotic therapy (< 14 days) has been associated with higher rates of relapse [3]. Findings of McGuire et al are therefore supported by prior studies upon which the current guideline recommendations are based. Furthermore, a number of studies have reported the benefits of consultation with infectious disease specialists in treating patients with S. aureus bacteremia, with regards to outcomes including relapse rates [4] and mortality [5]. Considering the sample size, the statistically nonsignificant benefit of infectious disease specialist consultation that the authors observed may be because of the insufficient power, although the results are generally supportive of the past studies. We agree with the authors that source control, which is often included in management bundles [6], is quite important in treating S. aureus bacteremia, and the benefit of early source control has been reported by a number of studies.
Our study, in contrast, served to provide an estimate of 30-day readmission rate at the US national level, which was a knowledge gap, using an administrative database specialized in readmission analysis [7]. The data included a large number of hospitals with a variety of practice settings ranging from academic hospitals to nonacademic rural hospitals, and outcomes varied across institutions. Standardized care approach is associated with improved outcomes [8], but the care should be tailored to each hospital’s epidemiologic data and patient characteristics. The estimates we provided can serve as the benchmark in conducting quality control studies.
Improvement in outcomes of S. aureus bacteremia is a goal shared by the entire medical community. In aiming for this goal, identification of knowledge gaps and approaches from different angles is crucial. Therefore, both our database analysis data, and the real-life, granular data described by the authors would contribute to the understanding of how these patients could be best managed in different settings. We heartily agree with McGuire et al that further research is needed to identify optimal management strategies in improving care for S. aureus bacteremia.
Note
Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
