SABATO Trial Outcomes: Hospital Stay Duration
Patients who switched to oral therapy had significantly shorter hospital stays than did patients who received intravenous therapy in the SABATO trial.
Understanding the SABATO Trial
The SABATO (Staphylococcus Aureus Bacteremia Antibiotic Treatment Options) trial was designed to evaluate whether early oral switch therapy (OST) is non-inferior to conventional intravenous standard therapy (IST) in patients with low-risk Staphylococcus aureus bloodstream infection 1. This trial specifically examined outcomes including hospital length of stay and complications related to therapy.
Key Findings Regarding Hospital Stay Duration
The trial demonstrated that patients who were switched to oral therapy experienced significantly shorter hospital stays compared to those who remained on intravenous therapy. This finding aligns with established evidence that early switch to oral antibiotics can reduce length of hospitalization without compromising patient outcomes.
Supporting Evidence from Guidelines
The Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) consensus guidelines support this approach, stating that patients should be discharged as soon as they are clinically stable, have no other active medical problems, and have a safe environment for continued care 2. Furthermore, they explicitly note that "inpatient observation while receiving oral therapy is not necessary" and that continuing intravenous therapy unnecessarily "only adds to cost and length of stay, without any measurable clinical benefit" 2.
Criteria for Safe Oral Switch
For safe transition to oral therapy, patients should meet specific criteria:
- Improvement in clinical symptoms (cough, dyspnea)
- Afebrile status (≤100°F) for at least 8 hours
- Decreasing white blood cell count
- Functioning gastrointestinal tract with adequate oral intake 2, 3
Most non-ICU patients meet these criteria within the first 3-7 days of hospitalization 2, 3.
Additional Benefits of Early Oral Switch
Beyond shorter hospital stays, early switch to oral antibiotics offers several advantages:
- Fewer complications related to intravenous therapy
- Reduced healthcare costs
- Improved patient comfort and mobility
- Lower risk of hospital-acquired infections 4, 5, 6
Specific Patient Considerations
It's important to note that while early oral switch therapy is beneficial for most patients, certain populations require special consideration:
- Patients with S. aureus bacteremia generally need longer IV therapy to prevent complications like endocarditis 2, 3
- Patients with severe infections or immunocompromised status may require extended IV therapy 3
Conclusion on SABATO Trial Outcomes
The SABATO trial provides important evidence that early switch to oral antibiotics significantly reduces hospital length of stay compared to continued intravenous therapy in appropriate candidates. This finding is consistent with other studies showing that sequential intravenous-to-oral antibiotic therapy can reduce hospitalization duration by approximately 6-7 days 4, 7.
This approach represents an important strategy for improving healthcare efficiency while maintaining positive patient outcomes in terms of morbidity, mortality, and quality of life.