Long-term infectious complications and their relation to treatment duration in catheter-related Staphylococcus aureus bacteremia

The optimal duration of treatment for catheter-related Staphylococcus aureu s bacteremia is not known. Short courses (less than or equal to 2 weeks) of therapy should be viewed with caution because essential data on late compl ications, such as osteomyelitis and metastatic abscesses, are lacking. This study represents a retrospective analysis of the data from 49 adult patien ts hospitalised in the period 1994-1996 (mean age, 57 years; range, 20-90 y ears; 47% male) and from whom Staphylococcus aureus was cultured concomitan tly from peripheral blood and catheter segments. Forty-six venous catheters , two arterial catheters, and one unknown type of catheter were used. Forty -four patients were treated with effective anti-Staphylococcus aureus antib iotics. Twenty patients had a favourable outcome, defined as no complicatio n and no death during 1 year of follow-up, 24 patients had complications, 1 4 patients died due to attributable mortality, and 5 other patients died of an underlying disease without showing signs or symptoms of a complication. Patients were categorised according to the duration of treatment. There we re small differences between a shorter (1-14 days) and a longer (> 14 days) course of antibiotics with regard to favourable outcome (41% vs. 33%), com plications (48% vs. 53%), attributable death (31% vs. 20%), and death due t o underlying disease (41% vs. 33%), respectively. The rates of complication s and death were high, but a definite conclusion cannot be drawn because th e study was underpowered. More randomised trials are needed, but, until the results of such trials are available, the duration of therapy should not b e shortened to less than 14 days.