International study investigating the best treatment for Staphylococcus aureus bacteremia open at Radboudumc

Staphylococcus aureus bacteremia (SAB) is a common and severe infection with a 90-day mortality of 15-30% despite current best available therapies. There are few high-quality data to inform the management of this infection, with less than 3000 patients randomised into any therapeutic trial for SAB prior to 2020. Recently, the Staphylococcus aureus Network Adaptive Platform (SNAP) trial, an Australian initiative, is started in different countries. The SNAP trial is an adaptive platform trial, i.e. it allows multiple questions to be evaluated simultaneously and sequentially within the platform, and evaluate interactions between different treatment options, to achieve the goal of determining the optimal combination of treatments for the disease as rapidly as possible.

On October 26, the Radboudumc entered the SNAP trial, together with UMC Utrecht as first Dutch hospitals. Later this year, also Maastricht UMC, Treant, Ikazia, Martini, Antonius Sneek and the Rijnstate hospital will be opened as study sites. It is expected that more hospitals will follow next year. The Radboudumc researchers, including hospital pharmacist-researcher Fleur Sinkeler, hospital pharmacists Nynke Jager and Roger Brüggemann and infectiologists Ilse Kouijzer and Jaap ten Oever, want to find out what the safest and most effective treatment is for patients dealing with a bloodstream infection caused by the bacterium Staphylococcus aureus. All patients (≥18 years) with S. aureus bacteremia can be included in this study, where they will be randomized to the antibiotics benzylpenicillin or flucloxacillin, or cefazolin or flucloxacillin, based on the sensitivity of S. aureus. In addition, two sub-studies (CAESAR) are being conducted in the Netherlands, with the aim of investigating a relationship between exposure and clinical outcome (pharmacokinetics-pharmacodynamics) and possible differences in the presence of resistant bacteria when treated with cefazolin versus flucloxacillin. Funding for this trial was granted to the above mentioned study team by ZonMW, Rational Pharmacotherapy program 2022. This grant (together with additional funding from ECRAID) allows the participation of 10 Dutch hospitals in this large international trial.

ZonMw project Redefining antimicrobial treatment of Staphylococcus aureus bacteraemia