JAMA Author Interviews Treatment of Complicated Staphylococcus aureus Bacteremia
Aug 13, 2025
In this insightful conversation, Thomas L. Holland, an infectious disease specialist at Duke University, delves into the challenges of treating complicated Staphylococcus aureus bacteremia. He discusses the promising results of the DOTS trial, which evaluates dalbavancin as a long-acting treatment option that may eliminate the need for prolonged IV access. Holland and host Preeti Malani explore the significance of the Desirability of Outcome Ranking in clinical trials and the surprising similarities in quality of life outcomes between different treatment approaches.
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Staph aureus Is Unusually Dangerous
- Staphylococcus aureus can infect many anatomic sites and prosthetic materials, making it uniquely challenging to treat.
- Its high 90-day mortality (>25%) underscores the severity and need for improved management.
Stop Prolonged IV Use When Not Needed
- Avoid relying on prolonged IV therapy when safe alternatives exist because many patients stabilize long before treatment completion.
- Consider options that spare patients long-term IV access when source control and bacteremia clearance are achieved.
Test Promising Antibiotics Through Trials
- Consider enrolling eligible patients in trials or using evidence-based alternatives like dalbavancin when appropriate.
- Use established research networks (like ARLG) to evaluate promising but untested antibiotics for deep infections.