JAMA Clinical Reviews Treatment of Complicated Staphylococcus aureus Bacteremia
Aug 13, 2025
Thomas L. Holland, an infectious disease specialist and professor at Duke University, discusses the innovative treatment of complicated Staphylococcus aureus bacteremia using Dalbavancin. He shares insights from the groundbreaking DOTS trial, which compares this long-acting antibiotic to traditional IV therapies, highlighting its potential to improve patient outcomes and quality of life. The conversation also addresses challenges in treatment, particularly for vulnerable populations, and the urgency of developing safer options for this serious infection.
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High Mortality And Complex Biology
- Staphylococcus aureus causes diverse, deep-seated infections and often resists antibiotics, making management complex.
- Even with improved care, 90-day mortality exceeds 25% for S. aureus bacteremia, underscoring high risk.
Mask Outcome Assessment In Open Trials
- When evaluating new therapies, use blinded adjudication of outcomes even in open-label trials.
- Implement objective review committees masked to treatment allocation to reduce bias in clinical endpoints.
Reconsider Prolonged IV Access
- Avoid relying solely on long-term IV access when patients clinically stabilize early during therapy.
- Consider alternatives to PICC/central lines when safe options exist to finish prolonged antibiotic courses.