Universität zu Köln

Rieg, Siegbert ORCID: 0000-0001-7493-7080, Ernst, Angela, Peyerl-Hoffmann, Gabriele, Joost, Insa, Camp, Johannes ORCID: 0000-0003-3914-4477, Hellmich, Martin, Kern, Winfried, V, Kaasch, Achim J. and Seifert, Harald (2020). Combination therapy with rifampicin or fosfomycin in patients with Staphylococcus aureus bloodstream infection at high risk for complications or relapse: results of a large prospective observational cohort. J. Antimicrob. Chemother., 75 (8). S. 2282 - 2291. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Objectives: To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin. Methods: In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs). Results: A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46-0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35-0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36-0.91). Upon agentspecific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions. Conclusions: In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rieg, Siegbert UNSPECIFIED orcid.org/0000-0001-7493-7080 UNSPECIFIED Ernst, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Peyerl-Hoffmann, Gabriele UNSPECIFIED UNSPECIFIED UNSPECIFIED Joost, Insa UNSPECIFIED UNSPECIFIED UNSPECIFIED Camp, Johannes UNSPECIFIED orcid.org/0000-0003-3914-4477 UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, Winfried, V UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaasch, Achim J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, Harald UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-324347
DOI:	10.1093/jac/dkaa144
Journal or Publication Title:	J. Antimicrob. Chemother.
Volume:	75
Number:	8
Page Range:	S. 2282 - 2291
Date:	2020
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2091
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BACTEREMIA; MANAGEMENT; ENDOCARDITIS; DIAGNOSIS; CARE Multiple languages Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32434