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Background <p><i>Staphylococcus aureus</i> bacteremia (SAB) is a&#xa0;heterogeneous and difficult-to-treat disease with a&#xa0;high mortality rate.</p> Objectives <p>Presentation of the challenges of randomized controlled trials (RCTs) on SAB, and an overview of the current state of research and future studies.</p> Methods <p>Search for RCTs on SAB in PubMed and clinicaltrials.gov over the past 20&#xa0;years.</p> Results <p>The design and implementation of RCTs on SAB is complex. Current RCTs incorporate new developments such as pragmatic study design, adaptive platform studies, endpoints with a&#xa0;desirability of outcome ranking (DOOR) and enrichment of clinical phenotypes. The latest results regarding therapy show that cefazolin is not inferior to flucloxacillin in the treatment of methicillin-susceptible <i>S.&#xa0;aureus</i> (MSSA)-SAB and is less nephrotoxic. There is no general recommendation for combination therapy. In low-risk SAB, early oral switch therapy is possible after 5–7&#xa0;days.</p> Conclusions <p>RCTs on SAB therapy require careful planning and inclusion of subgroups. Further RCTs are necessary to optimize therapy.</p>

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Staphylococcus-aureus-Bakteriämie – der lange Weg zur adäquaten Therapie

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Jana Butzmann,
  • Achim J. Kaasch

摘要

Background

Staphylococcus aureus bacteremia (SAB) is a heterogeneous and difficult-to-treat disease with a high mortality rate.

Objectives

Presentation of the challenges of randomized controlled trials (RCTs) on SAB, and an overview of the current state of research and future studies.

Methods

Search for RCTs on SAB in PubMed and clinicaltrials.gov over the past 20 years.

Results

The design and implementation of RCTs on SAB is complex. Current RCTs incorporate new developments such as pragmatic study design, adaptive platform studies, endpoints with a desirability of outcome ranking (DOOR) and enrichment of clinical phenotypes. The latest results regarding therapy show that cefazolin is not inferior to flucloxacillin in the treatment of methicillin-susceptible S. aureus (MSSA)-SAB and is less nephrotoxic. There is no general recommendation for combination therapy. In low-risk SAB, early oral switch therapy is possible after 5–7 days.

Conclusions

RCTs on SAB therapy require careful planning and inclusion of subgroups. Further RCTs are necessary to optimize therapy.