Does Staphylococcus Aureus Bacteremia Early Dual Therapy Improve Outcomes?

NCT ID: NCT07148960

Last Updated: 2025-09-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ENROLLING_BY_INVITATION

Clinical Phase

PHASE4

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-15

Study Completion Date

2027-07-31

Brief Summary

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The goal of this open-label, pragmatic, randomized controlled clinical trial is to learn if patients with Staphylococcus aureus bacteremia (SAB) given the intervention of early dual intravenous (IV) antibiotic therapy will decrease duration of bacteremia (\< 6 days) and improve outcomes compared to single IV antibiotic therapy.

The main questions this study aims to answer are:

* To decrease SAB duration and improve outcomes by using early dual vs. single agent IV antibiotic therapy
* To accelerate practice transformation of earlier IV to oral (PO) antibiotic transition by switching to PO antibiotic therapy once blood cultures are negative at 72 hours

Participants will be asked to agree to be randomized (like flipping a coin) to receive two or one IV antibiotic(s). Once the infection has cleared, the treatment will be changed to PO antibiotics. As part of usual care, participants will have weekly lab tests for monitoring while on antibiotics, receive a telephone call to see how the participants are doing, and follow up in person or by telephone or video in Infectious Diseases (ID) Clinic. Participant participation will last 12 weeks after the participant is discharged from the hospital.

Detailed Description

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Conditions

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Staphylococcus Aureus Bacteremia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Early Dual IV Antibiotic Therapy

Once type of Staphylococcus aureus bacteremia (MRSA vs. MSSA) is determined the following IV antibiotics will be given:

* MRSA - daptomycin plus ceftaroline;
* MSSA - cefazolin plus ertapenem;
* MRSA or MSSA - rifampin PO may be added for patients with prosthetic material

Group Type EXPERIMENTAL

Early Dual IV Antibiotic Therapy - MRSA

Intervention Type DRUG

Participant given IV daptomycin plus ceftaroline dosing per standard of care. Oral rifampin may be added for participants with prosthetic material.

Early Dual IV Antibiotic Therapy - MSSA

Intervention Type DRUG

Participant given IV cefazolin plus ertapenem dosing per standard of care. Oral rifampin may be added for participants with prosthetic material.

Single Agent IV Antibiotic Therapy

Once type of Staphylococcus aureus bacteremia (MRSA vs. MSSA) is determined the following IV antibiotics will be given:

* MRSA - daptomycin, vancomycin, or ceftaroline;
* MSSA - cefazolin, oxacillin, or nafcillin;
* MRSA or MSSA - rifampin PO may be added for patients with prosthetic material

Group Type ACTIVE_COMPARATOR

Single Agent IV Antibiotic Therapy - MRSA

Intervention Type DRUG

Participant given one of the following IV therapies: daptomycin, vancomycin, or ceftaroline. Oral rifampin may be added for participants with prosthetic material.

Single Agent IV Antibiotic Therapy - MSSA

Intervention Type DRUG

Participant given one of the following IV therapies: cefazolin, oxacillin, or nafcillin. Oral rifampin may be added for participants with prosthetic material.

Interventions

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Early Dual IV Antibiotic Therapy - MRSA

Participant given IV daptomycin plus ceftaroline dosing per standard of care. Oral rifampin may be added for participants with prosthetic material.

Intervention Type DRUG

Early Dual IV Antibiotic Therapy - MSSA

Participant given IV cefazolin plus ertapenem dosing per standard of care. Oral rifampin may be added for participants with prosthetic material.

Intervention Type DRUG

Single Agent IV Antibiotic Therapy - MRSA

Participant given one of the following IV therapies: daptomycin, vancomycin, or ceftaroline. Oral rifampin may be added for participants with prosthetic material.

Intervention Type DRUG

Single Agent IV Antibiotic Therapy - MSSA

Participant given one of the following IV therapies: cefazolin, oxacillin, or nafcillin. Oral rifampin may be added for participants with prosthetic material.

Intervention Type DRUG

Other Intervention Names

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daptomycin ceftaroline rifampin cefazolin ertapenem rifampin daptomycin vancomycin ceftaroline rifampin cefazolin oxacillin nafcillin rifampin

Eligibility Criteria

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Inclusion Criteria

* The patient is hospitalized at J.W. Ruby Memorial Hospital, Berkeley Medical Center, Camden Clark Medical Center, Princeton Community Hospital, Thomas Hospital, United Hospital Center, or Wheeling Hospital
* The patient has been identified to have Staphylococcus aureus bacteremia
* The patient is able to participate in lab monitoring and in-person or telemedicine ID Clinic follow-up

Exclusion Criteria

* The patient or an appointed medical decision maker is unable to give informed consent
* The patient is a prisoner, pregnant, and/or mentally handicapped
* The patient is determined unsafe for enrollment at the primary team's discretion
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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West Virginia University

OTHER

Sponsor Role lead

Responsible Party

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Joy J. Juskowich, MD

Assistant Professor and COpAT Medical Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Joy J Juskowich, MD

Role: PRINCIPAL_INVESTIGATOR

West Virginia University

Arif R Sawari, MD, MSc, MBA

Role: PRINCIPAL_INVESTIGATOR

West Virginia University

Locations

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West Virginia University

Morgantown, West Virginia, United States

Site Status

Countries

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United States

References

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Kim M, Ranganath N, Chesdachai S, Stevens RW, Sohail MR, Abu Saleh OM. Which trial do we need? Combination therapy with daptomycin plus ceftaroline versus standard-of-care monotherapy in the treatment of methicillin-resistant Staphylococcus aureus bacteraemia. Clin Microbiol Infect. 2025 Jan;31(1):18-21. doi: 10.1016/j.cmi.2024.08.011. Epub 2024 Sep 7. No abstract available.

Reference Type BACKGROUND
PMID: 39182576 (View on PubMed)

Juskowich JJ, Thompson JM, Bage SD, et al. Implementing the Comparing Oral versus Parenteral Antimicrobial Therapy (COPAT) Clinical Trial to Influence Institutional Practice Transformation Towards Earlier Transition to Oral Antibiotics. Accepted for an Oral Presentation at IDWeek 2025 in Atlanta, GA.

Reference Type BACKGROUND

Juskowich JJ, Thompson JM, Guilfoose JG, et al. P-106. Preliminary Results of the Comparing Oral versus Parenteral Antimicrobial Therapy (COPAT) Clinical Trial. Open Forum Infect Dis 2025;12(1):S197-198.

Reference Type BACKGROUND

Juskowich JJ, Thompson JM, Sarwari AR. 333. How the COVID-19 Pandemic Accelerated Development of our Complex Outpatient Oral Antimicrobial Therapy (COpAT) Program. Open Forum Infect Dis 2023;10(2):S212.

Reference Type BACKGROUND

Juskowich JJ, Ward A, Spigelmyer AE, et al. 1002. Complex Outpatient Antimicrobial Therapy (COpAT) Program at a Rural Academic Medical Center: Evaluation of First 100 Patients. Open Forum Infect Dis 2022;9(2):S418-S419.

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Kaasch AJ, Lopez-Cortes LE, Rodriguez-Bano J, Cisneros JM, Dolores Navarro M, Fatkenheuer G, Jung N, Rieg S, Lepeule R, Coutte L, Bernard L, Lemaignen A, Kosters K, MacKenzie CR, Soriano A, Hagel S, Fantin B, Lafaurie M, Talarmin JP, Dinh A, Guimard T, Boutoille D, Welte T, Reuter S, Kluytmans J, Martin ML, Forestier E, Stocker H, Vitrat V, Tattevin P, Rommerskirchen A, Noret M, Adams A, Kern WV, Hellmich M, Seifert H; SABATO study group. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis. 2024 May;24(5):523-534. doi: 10.1016/S1473-3099(23)00756-9. Epub 2024 Jan 17.

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Reference Type BACKGROUND
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Comba IY, Go JR, Vaillant J, O'Horo JC, Stevens RW, Palraj R, Abu Saleh O. Sequential Time to Positivity as a Prognostic Indicator in Staphylococcus aureus Bacteremia. Open Forum Infect Dis. 2024 Mar 21;11(4):ofae173. doi: 10.1093/ofid/ofae173. eCollection 2024 Apr.

Reference Type BACKGROUND
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Cao Y, Guimaraes AO, Peck MC, Mayba O, Ruffin F, Hong K, Carrasco-Triguero M, Fowler VG Jr, Maskarinec SA, Rosenberger CM. Risk stratification biomarkers for Staphylococcus aureus bacteraemia. Clin Transl Immunology. 2020 Feb 13;9(2):e1110. doi: 10.1002/cti2.1110. eCollection 2020.

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Bai AD, Lo CKL, Komorowski AS, Suresh M, Guo K, Garg A, Tandon P, Senecal J, Del Corpo O, Stefanova I, Fogarty C, Butler-Laporte G, McDonald EG, Cheng MP, Morris AM, Loeb M, Lee TC. Staphylococcus aureus bacteraemia mortality: a systematic review and meta-analysis. Clin Microbiol Infect. 2022 Aug;28(8):1076-1084. doi: 10.1016/j.cmi.2022.03.015. Epub 2022 Mar 23.

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Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, Bruun NE, Hofsten DE, Fursted K, Christensen JJ, Schultz M, Klein CF, Fosboll EL, Rosenvinge F, Schonheyder HC, Kober L, Torp-Pedersen C, Helweg-Larsen J, Tonder N, Moser C, Bundgaard H. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019 Jan 31;380(5):415-424. doi: 10.1056/NEJMoa1808312. Epub 2018 Aug 28.

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Other Identifiers

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2507187207

Identifier Type: -

Identifier Source: org_study_id

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