Duke Health researchers have successfully created a checklist for patients with staphylococcal bloodstream infections to determine which patients can terminate antibiotic treatment sooner than others.

Using what was known in medical literature and clinical experience, researchers at Duke were able to develop and test an algorithm that can successfully determine and decrease the amount of antibiotics that people afflicted with staph infection must use. This algorithm was shown to help patients with uncomplicated staph infections stop antibiotics almost two days sooner than patients that received standard care, transforming the way antibiotics are used.

Staphylococcus is a type of bacteria that can invade the body through abrasions or cuts and spread to different parts of the body to cause numerous deadly diseases. 

Thomas Holland, assistant professor of medicine, said his team decided to target staph infections because it is the most common bloodstream infection seen in hospitals.

“[Staph infections] cause a lot of morbidity and even mortality, especially staph aureus. It’s a type that's associated with high mortality," Holland said. "And so, the ability to improve the way we manage these infections was the impetus to do the work."

Treatment of staph infections involves heavy antibiotic use. Currently, Vancomycin is the most prescribed antibiotic in hospitals in the United States to treat a serious type of infection—infections by gram-positive bacteria. 

However, with the widespread use of this antibiotic, the bacteria the antibiotic is supposed to target has naturally and rapidly developed a resistance. Some staph infections already no longer respond, putting the lives of many patients in jeopardy.

“Antibiotic resistance is certainly at the forefront of our concerns in infectious disease and in medical care in general. Staph aureus is one of the pathogens that the [Centers for Disease Control and Prevention] has identified as a priority pathogen that we need better treatments for,” Holland said.

With this algorithm, the researchers are trying to achieve a number of goals. Decreasing the amount of antibiotics patients are exposed to could first reduce the side effects for patients and help them avoid prolonged hospital stays. Using less antibiotics also benefits public health by decreasing the likelihood of antibiotic resistance and improving how infectious diseases can be managed and treated.

The study took a total of about nine years from design to publication and involved patients throughout the United States and Spain. During this long, arduous process, one of the most difficult hurdles was enrolling patients with particularly ill cases, as they were unwilling to participate in the research projects for various reasons, Holland said. 

Despite the long process, Holland said that he finds great meaning in his work from personal experiences he’s had in seeing the difficult conditions of his patients as a healthcare provider. 

“I decided to pursue infectious diseases because I really enjoyed thinking about the ability to bring a treatment algorithm to those patients with the prospect of helping manage their infection better," Holland said. "That’s the goal, and that’s what we’re after."