2024 S aureus and MRSA Trials: Key Takeaways
Jeffrey Freiberg, MD, PhD review of the SABATO trial on oral antibiotics for S aureus bacteremia and a comparison of mupirocin and iodine treatments for MRSA decolonization.
Clinical science in infectious diseases saw significant progress in 2024, with multiple clinical trials of new antibiotics and infection prevention strategies. The year also brought public health challenges, including outbreaks and AMR, underscoring the continued need for research and clinical interventions.1
At IDWeek 2024, experts gathered to review these developments and ongoing challenges. The What's Hot in ID Clinical Science session highlighted key trials and trends from the past year. While many studies were discussed, this review focuses on findings that may influence future clinical practice.1
SABATO Trial on Oral Antibiotics for S aureus Bacteremia:
One notable development was the SABATO trial, which examined the use of oral antibiotics as a step-down treatment for Staphylococcus aureus (S aureus) bacteremia. The study investigated whether oral antibiotics could replace intravenous (IV) antibiotics in select patients for a 14-day regimen. While the trial found that oral antibiotics were safe and effective in a specific patient population, concerns about the strict criteria for patient selection remain.2
In this part of our interview with Jeffrey Freiberg, MD, PhD, assistant professor at Vanderbilt University Medical Center, he discussed the implications of the SABATO trial, “There’s been a lot of focus in recent years on studying oral antibiotics. We know that in many cases, oral antibiotics are safer than continuing someone on IV antibiotics. There’s a lot of interest in determining when we can use oral antibiotics. I think with Staphylococcus aureus, the SABATO trial was interesting because it studied two things. It looked at both oral antibiotics and also whether you can treat for 14 days with S aureus bacteremia. The study clearly showed that for the patient population they chose, oral antibiotics for 14 days were safe and effective,” Freiberg noted.
Although, Freiberg pointed out that the trial's applicability to a broader patient population is still uncertain. “The question really becomes: How many patients did they have to screen to find those they felt comfortable treating for 14 days? And how closely do physicians feel they need to stick to those strict criteria to limit treatment to just 14 days? I think the study does a good job of encouraging people to feel comfortable with using oral antibiotics, but the question still remains: Who can we actually treat for just 14 days for S aureus bacteremia?”
MRSA Decolonization: Comparing Mupirocin and Iodine-Based Treatments
A large-scale study compared the efficacy of mupirocin and iodine-based treatments (povidone-iodine) for nasal decolonization, a strategy designed to reduce the risk of hospital-acquired MRSA infections. While mupirocin has been a long-standing standard for MRSA decolonization, concerns about rising mupirocin resistance have sparked interest in alternative treatments.1
Freiberg explained the growing concern over mupirocin resistance: “The thought behind this study is that we had good data showing that mupirocin decolonization, along with chlorhexidine bathing, was effective at reducing the risk of hospital-acquired MRSA infections, or staph infections in general. However, mupirocin resistance is growing, and in many places, they don’t keep good track of how much resistance they’re seeing. The concern is that mupirocin use for decolonization could lead to increased resistance over time.”
Despite the concerns surrounding mupirocin resistance, the study found that mupirocin was still more effective than iodine in reducing hospital-acquired MRSA infections. Freiberg further explained: “The question was, could we use iodine (povidone-iodine) for decolonization instead? In terms of efficacy, this study showed that mupirocin is still more effective at reducing the risk of hospital-acquired staph infection. Whether this changes over time, as mupirocin resistance rises, remains to be seen. But at least for now, in a large study across many different hospitals, mupirocin definitely came out as the clear winner.”
