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• W4328142627 abstract "We appreciate the comments of Martellosio et al for outlining the role of oral antibiotics in cases of Staphylococcus aureus bacteremia and agree that its usage in select cases of this condition is warranted and requires further study. As the readership of The American Journal of Medicine includes non-infectious diseases clinicians, our focus was to outline the lethality associated with S. aureus bacteremia and emphasize other relevant pillars of treatment—including echocardiogram, selection of empiric anti-staphylococcal therapy, and careful assessment for source control and metastatic phenomena.1Lam JC Stokes W The golden grapes of wrath – Staphylococcus aureus bacteremia: a clinical review.Am J Med. 2023; 136: 19-26Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar We acknowledge that no two cases of S. aureus bacteremia are identical, and Infectious Disease consultation is critical. Where Infectious Disease consultation is not readily available, the literature mentioned by the authors merits discussion. While Li et al2Li HK Rombach I Zambellas R et al.Oral versus Intravenous Antibiotics for Bone and Joint Infection.N Engl J Med. 2019; 380: 425-443Crossref PubMed Scopus (394) Google Scholar demonstrated noninferiority between oral and intravenous antibiotic treatment in a large heterogeneous group of bone and joint infections—these patients did not have S. aureus bacteremia. Furthermore, <7% of included patients had vertebral osteomyelitis. In Wald-Dicker et al,3Wald-Dickler N Holtom PD Phillips MC et al.Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.Am J Med. 2022; 135: 369-379Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar the majority of studies assessed excluded vertebral osteomyelitis. Vertebral osteomyelitis is a common cause or complication of S. aureus bacteremia, and the data for oral antibiotics to treat vertebral osteomyelitis with S. aureus bacteremia is limited.4Talha KM Baddour LM Ishaq H et al.Native vertebral osteomyelitis in patients with Staphylococcus aureus bacteremia.Am J Med Sci. 2022; 363: 140-146Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar For selected cases of nonvertebral S. aureus bone or joint infection with uncomplicated S. aureus bacteremia, we agree with Martellosio et al that oral therapy is reasonable after a course of intravenous treatment and sterilization of blood cultures. However, decisions on timing of oral therapy benefit from infectious disease consultation. Furthermore, not all oral therapies used in S. aureus bacteremia are equivalent. In the randomized controlled trials assessed by Wald-Dickler et al, linezolid was the most common oral therapy for S. aureus bacteremia. While linezolid may be a rational choice for treating S. aureus bacteremia in select circumstances, its adverse effect profile and cost may render prolonged usage impractical. As such, extrapolation of these data to other routinely used antibiotics (eg, oral beta-lactams) is uncertain. The POET study by Iversen et al,5Iversen K Ihlemann N Gill SU et al.Partial oral versus intravenous antibiotic treatment of endocarditis.N Engl J Med. 2019; 380: 415-424Crossref PubMed Scopus (1) Google Scholar which examined oral therapy for left-sided endocarditis, is indeed intriguing and with potential to be practice changing. However, methicillin-sensitive S. aureus represented the minority of causative organisms studied, and cases of methicillin-resistant S. aureus endocarditis were excluded. The frequency of follow-up for patients in the POET study may not be practical in settings without infectious disease clinicians. We thank Martellosio et al for their thoughtful comments and agree that further studies to identify orally bioavailable anti-staphylococcal therapies to use in specific patients with S. aureus bacteremia will be critical—and look forward to the additional data that the RODEO and SNAP trials will provide in cases of S. aureus bacteremia with endocarditis." @default.
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• W4328142627 title "The Reply" @default.
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