Staphylococcus Aureus BacteremiaPhase 4SNAPNCT05137119
Staphylococcus Aureus Network Adaptive Platform Trial
A Phase 4 study testing Cefazolin, Penicillin and Clindamycin in people with Staphylococcus Aureus Bacteremia, run by University of Melbourne at 161 sites in 13 countries.
Trial summary
The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is an International Multi-Centered Randomised Adaptive Platform Clinical Trial to evaluate a range of interventions to reduce mortality for patients with Staphylococcus Aureus bacteraemia (SAB). Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Staphylococcus Aureus Bacteremia
- What is being tested?
- Cefazolin, Penicillin and Clindamycin
- Type of treatment
- Pill or oral medicine, Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 8,000 participants
- Where
- 161 sitesin 13 countries
- Study dates
- 16 Feb 2022to 1 Dec 2028
- Phase
- Phase 4
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- All participants that met the PLATFORM eligible are eligible to be included in this domain unless they meet any of the following exclusions listed.
- Patients are eligible for this domain regardless of S. aureus susceptibility testing results to clindamycin.
- For PSSA silo: Index blood culture isolate is penicillin-susceptible as per the Microbiology Appendix. In short, this will require phenotypic disc testing with EUCAST (a P1 disc diffusion with zone >=26mm OR a P1 disc diffusion with zone >=26mm and the zone edge is NOT sharp) OR CLSI (a P10 disc diffusion) defined criteria.
- For MSSA silo: Index blood culture isolate is methicillin-susceptible as per the Microbiology Appendix.
- Note that where trial sites are not testing for penicillin-susceptibility, patients with MSSA/PRSA can be included in the MSSA silo, but those with MSSA/PSSA (but not confirmed with a P-disc) will be excluded from the backbone domain. The rationale for this is that patients with MSSA but not tested with a P-disc may be truly PSSA (with no blaZ). If the cefazolin inoculum effect (CIE) is a clinically relevant entity, then including patients with an organism without blaZ (and hence cannot have a CIE phenotype), will bias towards non-inferiority of cefazolin compared to (flu)cloxacillin.
- For PSSA, the requirement for laboratories to use an accredited phenotypic test for a penicillin-susceptible phenotype, is to ensure clinical safety according to internationally accepted guidelines. The automated antimicrobial susceptibility testing, and other phenotypic tests, have poor sensitivity for detection of blaZ compared to a gold standard of blaZ PCR. Therefore, patients could be placed at risk of treatment with benzylpenicillin when the infecting isolate is actually blaZ positive, unless these guidelines are followed.
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- 1. MRSA confirmed microbiologically
- Day 7 (+/- 2 days):
- Clearance of SAB by platform Day 2: blood cultures negative for S. aureus from platform Day 2 onwards AND no known subsequent positive blood cultures
- Afebrile (<37.8°C) for the past 72 hours (at time of judging eligibility)
- Primary focus is either line related (either central or peripheral IV cannula) or skin and soft tissue, AND source control achieved (for 'line-related' this means line removed; for 'skin and soft tissue' means site PI considers source control to have been achieved and any abscess more than 2cm diameter has been drained)
- No evidence of metastatic foci (on clinical or radiological examination, but radiological imaging is not required to exclude metastatic foci if not clinically indicated)
- Day 14 (+/- 2 days):
- Clearance of SAB by platform Day 5: blood cultures negative for S. aureus from platform Day 5 (+/-1 day) AND no known subsequent positive blood cultures. If the most recent blood culture from Day 2-4 is negative for S. aureus, blood cultures do not need to be repeated on Day 5 to fulfil eligibility criteria (Day 5 blood cultures will be assumed to be negative in this situation)
- Afebrile (<37.8°C) for the past 72 hours (at time of judging eligibility)
- Site Principal Investigator has determined that source control is adequate
- PET/CT participating site
- Patient is accessible for PET/CT - a patient is considered accessible if the site team are able to access the participant medical records, arrange for a PET/CT scan for the patient, and discuss this domain with the patient and their treating healthcare providers.
Who cannot join
- 1. Previous type 1 hypersensitivity reaction to lincosamides 2. Currently receiving clindamycin (lincomycin) or linezolid which cannot be ceased or substituted 3. Necrotising fasciitis 4. Current C. difficile associated diarrhoea (any severity) 5. Current severe diarrhoea from any cause (defined as Grade 3 or higher) 5. Known CDAD (C.Difficile Associated Diarrhoea) in the past 3 months, or CDAD relapse in the past 12 months 6. At the time of domain eligibility assessment, more than 4 hours has elapsed since platform entry 7. Treating clinician deems enrolment in this domain is not in the best interest of the patient
- PSSA, MSSA TREATMENT DOMAIN (backbone)
- >72 hours have elapsed since the collection of the index blood culture (i.e. the time of collection of the first positive blood culture from the patient during this episode)
- History of type I hypersensitivity reaction (i.e. anaphylaxis or angioedema) to any penicillin or cephalosporin
- History of severe delayed reaction (e.g. allergic interstitial nephritis, cutaneous vasculitis, Stevens-Johnson, DRESS, etc.) to any penicillin or cephalosporin
- PSSA silo: Non-severe rash to any penicillin (unless patient has been subsequently de-labelled; this criteria does not include criteria 2 and 3 above), or MSSA silo: Non-severe rash to cefazolin or any penicillin (unless patient has been subsequently de-labelled); (Nausea, diarrhoea, headache, and other non-specific symptoms are NOT allergies, they are drug intolerance, and they are not exclusion criteria. Similarly, a vague history of an allergy of unclear nature, or a family history of allergy are not exclusions.)
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- Treating team deems enrolment in this domain is not in the best interest of the patient
- Currently receiving maintenance dialysis (haemodialysis or peritoneal dialysis); (Acute renal replacement therapy (including CRRT, haemodialysis or peritoneal dialysis) are not exclusions. Such patients are eligible as long as appropriate vascular access is available or can be arranged.)
- Polymicrobial bacteraemia (defined as more than one organism [at species level] in blood cultures, excluding those organisms judged to be contaminants by either the microbiology laboratory or treating clinician) reported between collection of the index blood culture and backbone domain eligibility assessment
- Patient currently being treated with a systemic antibacterial agent that cannot be ceased or substituted for interventions allocated within the platform (unless antibiotic is listed in Table 1 of the DSA, which specifies allowed antibiotics with limited absorption from the gastrointestinal tract or negligible antimicrobial activity against S. aureus)
- MRSA TREATMENT DOMAIN (backbone)
- Time to allocation reveal is >72 hours from time of index blood culture collection
- Severe allergy to any beta-lactam (including cefazolin) Immediate severe allergy: Anaphylaxis/angioedema Severe delayed allergy: Severe cutaneous adverse reaction (SCAR; including Steven Johnson Syndrome, Toxic Epidermal Necrolysis, Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP)), severe drug induced liver injury, proven allergic interstitial nephritis, immune-mediated haemolytic anaemia and other severe cytopenia.
- Non-severe rash to cefazolin Nausea, diarrhoea, headache and other non-specific symptoms are NOT allergies, they are drug intolerance, and they are not exclusion criteria. Similarly, a vague history of an allergy of unclear nature, or a family history of allergy are not exclusions.)
- 3. Severe allergy or non-severe rash to both vancomycin AND daptomycin Vancomycin infusion reaction (formerly known as "red man syndrome") is due to direct histamine release and is not generally an allergy, and therefore is not considered an exclusion.
- 5. Treating team deems enrolment in the domain is not in the best interest of the patient 6. Polymicrobial bacteraemia (defined as more than one organism [at species level] in blood cultures, excluding those organisms judged to be contaminants by either the microbiology laboratory or treating clinician) reported between collection of the index blood culture and backbone domain eligibility assessment.
- 7. Patient currently being treated with a systemic antibacterial agent that cannot be ceased or substituted for interventions allocated within the platform (unless antibiotic is listed in Table 1 of the DSA, which specifies allowed antibiotics with limited absorption from the gastrointestinal tract or negligible antimicrobial activity against S. aureus)
- EARLY ORAL SWITCH DOMAIN
- When judging eligibility at platform Day 7 (+/- 2 days) and at Day 14 (+/- 2 days), exclusion criteria are:
- Adherence to oral agents unlikely (as judged by site PI in consultation with the treating team)
- Unreliable gastrointestinal absorption (e.g. vomiting, diarrhoea, nil by mouth, anatomical reasons)
- There are no appropriate oral antibiotics due to contraindications, drug availability, or antibiotic resistance
- Ongoing IV therapy unsuitable e.g. no IV access
- Clinician deems not appropriate for early oral switch
- Patient no longer willing to participate in domain In the lead-up to judging eligibility, it may be helpful to discuss with the patient the potential for continued IV treatment versus oral switch, to allow hospital discharge planning
- Clinical team deems that sufficient duration of antibiotic therapy has already been provided
- Exclusions when judging eligibility for early oral switch at trial Day 7 (+/- 2 days):
- Presence of prosthetic cardiac valve, pacemaker or other intracardiac implant
- Presence of intravascular clot, graft, or other intravascular prosthetic material Intravascular clot excludes superficial peripheral IV line-related thrombophlebitis. Intravascular prosthetic material excludes coronary artery stents)
- Intravascular/intracardiac infections (e.g. endocarditis, mycotic aneurysm)
- Presence of other intracardiac abnormalities felt to put patient at increased risk of endocarditis (e.g., bicuspid aortic valve)
- PET/CT DOMAIN
- Pregnant - patients of childbearing potential should be assessed for pregnancy status and a pregnancy test performed (if not performed within the past 10 days)
- Currently breastfeeding
- < 18 years of age
- Patient has had PET/CT in the past 7 days
- Patient needs PET/CT in the next 7 days (in the opinion of the clinical team, at the time of eligibility assessment)
- Clinically unstable for PET/CT (as judged by the treating clinical team, taking into account need for organ support (including inotropes) and capacity to lie flat for the PET/CT)
- Contraindication to PET/CT (e.g., claustrophobia, persistently elevated blood sugar levels [>12.5mmol/L] that cannot be corrected).
- Patient no longer willing to participate in the domain - in the days leading up to judging eligibility, it may be helpful to discuss with the patient the potential for PET/CT vs no PET/CT to allow imaging planning
- Clinician deems participation in this domain is not in the patient's best interests
Trial locations and contacts
161 sites in 13 countries. Contact the study team or a site near you to ask about taking part.
161 sites in 13 countries
Australia51 sites, 50 recruiting
- Recruiting
Lyell McEwin Hospital
Adelaide, South Australia, 5112
Rory Hannah
- Recruiting
Grampians Health
Ballarat, Victoria, 3350
Robert Commons
- Recruiting
Flinders Medical Centre
Bedford Park, South Australia, 5042
Nicholas Anagnostou
- Recruiting
Bendigo Health
Bendigo, Victoria, 3550
Andrew Mahony
- Recruiting
Sunshine Coast University Hospital
Birtinya, Queensland, 4575
David Sowden
Shradha Subedi
- Recruiting
Blacktown Hospital
Blacktown, New South Wales, 2148
Ravindra Dotel
- Recruiting
Box Hill Hospital
Box Hill, Victoria, 3128
Stephen Guy
- Recruiting
Cairns Hospital
Cairns, Queensland, 4870
Simon Smith
- Recruiting
Royal Prince Alfred Hospital
Camperdown, New South Wales, 2050
Sebastian VanHal
- Not yet recruiting
Monash Children's Hospital
Clayton, Victoria, 3168
Jeremy Carr
- Recruiting
Monash Health - Monash Medical Centre & Jesse McPherson Private Hospital
Clayton, Victoria, 3168
Ben Rogers
- Recruiting
Concord Repatriation and General Hospital
Concord, New South Wales, 2139
Genevieve McKew
Timothy Gray
- Recruiting
St Vincent's Hospital Sydney
Darlinghurst, New South Wales, 2010
Gail Matthews
- Recruiting
Western Health - Footscray, Joan Kirner & Sunshine Hospitals
Footscray, Victoria, 3011
Adrian Tramontana
- Not yet recruiting
Frankston Hospital
Frankston, Victoria, 3199
Kasha Singh
- Recruiting
Canberra Hospital
Garran, Australia Capital Territory, 2605
Heather Wilson
- Recruiting
Barwon Health - University Hospital Geelong
Geelong, Victoria, 3220
Eugene Athan
- Recruiting
Austin Hospital
Heidelberg, Victoria, 3084
Natasha Holmes
- Recruiting
Royal Brisbane and Women's Hospital
Herston, Queensland, 4029
Bridget Barber
- Not yet recruiting
Royal Hobart Hospital
Hobart, Tasmania, 7000
Peter Leung
- Recruiting
Ipswich Hospital
Ipswich, Queensland, 4305
John Woodford
- Recruiting
Nepean Hospital
Kingswood, New South Wales, 2747
Archana Sud
- Not yet recruiting
St George Hospital
Kogarah, New South Wales, 2217
Katy Lai
- Recruiting
Launceston Hospital
Launceston, Tasmania, 7250
Ali Trad
- Recruiting
Liverpool Hospital
Liverpool, New South Wales, 2170
Hong Foo
- Not yet recruiting
Logan Hospital
Meadowbrook, Queensland, 4131
Vichitra Sukumaran
- Recruiting
Alfred Hospital
Melbourne, Victoria, 3004
James McMahon
James McMahon
- Recruiting
Fiona Stanley Hospital
Murdoch, Western Australia, 6150
Owen Robinson
- Recruiting
Perth Children's Hospital
Nedlands, Western Australia, 6009
Asha Bowen
Anita Campbell
- Recruiting
John Hunter Hospital
New Lambton Heights, New South Wales, 2305
Brian Chong
- Recruiting
John Hunter Children's Hospital
Newcastle, New South Wales, 2305
Coen Butters
- Not yet recruiting
Women and Children's Hospital
North Adelaide, South Australia, 5006
Michael Stark
- Not yet recruiting
Women's and Children's Hospital
North Adelaide, South Australia, 5006
Nan Vasilunas
- Recruiting
Orange Health Service
Orange, New South Wales, 2800
Jacob Williams
- Recruiting
Royal Melbourne Hospital
Parkville, Victoria, 3050
Justin Denholm
- Recruiting
Royal Children's Hospital Melbourne
Parkville, Victoria, 3052
Amanda Gwee
- Recruiting
Royal Perth Hospital
Perth, Western Australia, 6000
Owen Robinson
- Recruiting
Armadale Hospital
Perth, Western Australia, 6112
David New
- Recruiting
Prince of Wales Hospital
Randwick, New South Wales, 2031
Trine Gulholm
- Recruiting
Sydney Children's Hospital
Randwick, New South Wales, 2031
Brendan McMullan
- Recruiting
Redcliffe Hospital
Redcliffe, Queensland, 4020
Kevin O'Callaghan
- Recruiting
Robina Hospital
Robina, Queensland, 4226
Peter Simos
- Completed
Goulburn Valley Health
Shepparton, Victoria, 3630
- Recruiting
Queensland Children's Hospital
South Brisbane, Queensland, 4101
Clare Nourse
- Recruiting
Gold Coast University Hospital
Southport, Queensland, 4215
Peter Simos
- Recruiting
Royal Darwin Hospital
Tiwi, Northern Territory, 0811
Jane Davies
Josh Francis
- Not yet recruiting
La Trobe Regional Hospital
Traralgon, Victoria, 3844
Zaal Meher-Homji
- Recruiting
The Children's Hospital at Westmead
Westmead, New South Wales, 2145
Philip Britton
- Recruiting
Westmead Hospital
Westmead, New South Wales, 2145
Matthew O'Sullivan
- Recruiting
Wollongong Hospital
Wollongong, New South Wales, 2500
Niladri Ghosh
- Not yet recruiting
Princess Alexandra Hospital
Woolloongabba, Queensland, 4102
Andrew Henderson
Canada37 sites, 33 recruiting
- Recruiting
Peter Lougheed Centre
Calgary, Alberta, T1Y 6J4
Ranjani Somayaji
- Recruiting
Foothills Medical Center
Calgary, Alberta, T2N4Z6
Ranjani Somayaji
- Recruiting
Rockyview Hospital
Calgary, Alberta, T2V 1P9
Ranjani Somayaji
- Recruiting
South Health Campus
Calgary, Alberta, T3M 1M4
Ranjani Somayaji
- Recruiting
Toronto East Health Network - Michael Garron Hospital
East York, Ontario, M4C3E7
Christopher Kandel
- Completed
University Health Network - Toronto General Hospital
East York, Ontario, M5G2C4
- Recruiting
University of Alberta Hospital
Edmonton, Alberta, T6G2B7
Stephanie Smith
- Recruiting
Hamilton Health Sciences - Hamilton General Hospital
Hamilton, Ontario, L8P1A2
Dominik Mertz
- Recruiting
Hamilton Health Sciences - Juravinski Hospital
Hamilton, Ontario
Dominik Mertz
- Recruiting
Kingston Health Sciences Centre - Kingston General Hospital
Kingston, Ontario, K7L2V7
Anthony Bai
- Recruiting
CISSS - Hôpital Cité-de-la-Santé Hospital
Laval, Quebec
Stephanie Castonguay
- Completed
London Health Sciences Centre - University Hospital, LHSC
London, Ontario
- Recruiting
Jewish General Hospital
Montreal, Quebec, H3T1E2
Leighanne Parkes
- Recruiting
McGill University Health Centre - Montral General Hospital
Montreal, Quebec, H4A3J1
Matthew Cheng
- Not yet recruiting
McGill University Health Centre - Montreal Children's Hospital
Montreal, Quebec
Jesse Pappenburg
- Recruiting
McGill University Health Centre - Royal Victoria Hospital
Montreal, Quebec
Matthew Cheng
- Recruiting
Niagara Health - Niagara Falls Site
Niagara Falls, Ontario
David McCullagh
- Recruiting
The Ottawa Hospital - Civic Campus
Ottawa, Ontario, K1H8L6
Derek MacFadden
- Recruiting
The Ottawa Hospital - General Campus
Ottawa, Ontario
Derek MacFadden
- Recruiting
Richmond Hospital
Richmond, British Columbia, V6X1A2
Clement Kwok
- Recruiting
Hôpital Régional de Saint Jérôme
Saint-Jérôme, Quebec, J7Z5T3
Sébastien Poulin
- Completed
Sault Area Hospital
Sault Ste. Marie, Ontario, P6B 0A8
- Recruiting
University of Sherbrooke Health Centre - Hospital Fleurimont
Sherbrooke, Quebec, J1H 5H3
Francois Lamontagne
- Recruiting
University of Sherbrooke Health Centre - Hotel Dieu
Sherbrooke, Quebec
Francois Lamontagne
- Recruiting
Niagara Health - St. Catharines Site
St. Catharines, Ontario, L2S 0A9
David McCullagh
- Recruiting
Eastern Health - Health Sciences Centre (Memorial University)
St. John's, Newfoundland and Labrador, A1B3V6
Peter Daley
- Recruiting
Eastern Regional Health Authority - St. Clare's Mercy Hospital
St. John's, Newfoundland and Labrador
Peter Daley
- Recruiting
Fraser Health Authority - Surrey Memorial Hospital
Surrey, British Columbia
Kevin Afra
- Recruiting
Unity Health - St Michael's Hospital
Toronto, Ontario, M1L 1W1
Matthew Muller
- Recruiting
Sunnybrook Health Sciences Centre
Toronto, Ontario, M4N3M5
Nick Daneman
- Recruiting
Sinai Heath System - Mount Sinai Hospital
Toronto, Ontario, M5G1X5
Jennie Johnstone
- Recruiting
Unity Health Toronto - St Joseph's Health Centre
Toronto, Ontario
Kevin Schwarz
- Completed
University Health Network - Toronto Western Hospital
Toronto, Ontario
- Recruiting
Vancouver General Hospital
Vancouver, British Columbia, V5Z1M9
Jennifer Grant
- Recruiting
St. Boniface Hospital
Winnipeg, Manitoba, R2H 2A6
Terry Wuerz
- Recruiting
Health Sciences Centre Winnipeg
Winnipeg, Manitoba, R3A1R9
Terry Wuerz
- Recruiting
Grace Hospital
Winnipeg, Manitoba, R3J 3M7
Terry Wuerz
United Kingdom34 sites, 34 recruiting
- Not yet recruiting
NHS Grampian
Aberdeen
Robin Brittain-Long
- Recruiting
University Hospitals Birmingham
Birmingham
James Scriven
- Recruiting
Brighton and Sussex University Hospitals
Brighton
Sunil Sharma
- Recruiting
North Bristol
Bristol
Ed Moran
- Recruiting
University Hospitals Bristol and Weston
Bristol
Raje Dhillon
- Not yet recruiting
Cambridge University Hospitals
Cambridge
Theodore Gouliouris
- Recruiting
Cardiff and Vale University
Cardiff
Jonathan Underwood
- Not yet recruiting
Royal Cornwall Hospitals
Cornwall
Ollie Lloyd
- Not yet recruiting
Royal Devon University Healthcare
Devon
Rachel Patel
- Not yet recruiting
NHS Tayside
Dundee
Nikolas Rae
- Recruiting
Lothian Western General
Edinburgh
Rebecca Sutherland
- Not yet recruiting
Greater Glasgow and Clyde
Glasgow
Michael Murphey
- Not yet recruiting
NHS Golden Jubilee
Glasgow
Fiona Thornburn
- Recruiting
Hull University Teaching Hospitals
Hull
Nick Easom
- Recruiting
Leeds Teaching Hospitals
Leeds
Fiona McGill
- Recruiting
Liverpool University Hospital
Liverpool
Steve Aston
- Recruiting
Barts Health
London
Mildred Iro
- Not yet recruiting
Great Ormond Street
London
James Hatcher
- Recruiting
Guys and St Thomas'
London
Anna Goodman
- Recruiting
Imperial College Healthcare
London
Claire Waddlington
- Not yet recruiting
Kings College Hospital
London
Jasmin Isalm
- Recruiting
Royal Free London
London
Indran Balakrishnan
- Recruiting
University College London Hospitals
London
Michael Marks
- Recruiting
Whittington Health
London
Ana Garcia Mingo
- Recruiting
Manchester University Hospitals
Manchester
Mike Riste
- Recruiting
Newcastle Upon Tyne Hospitals
Newcastle upon Tyne
Ashley (David) Price
- Not yet recruiting
Nottingham University Hospitals
Nottingham
Tim Sloan
- Recruiting
Oxford University Hospitals
Oxford
Matthew Scarborough
- Not yet recruiting
Sheffield Teaching Hospitals
Sheffield
Julia Grieg
- Recruiting
South Tees Hospitals
South Tees
John Widdrington
- Recruiting
University Hospital Southampton
Southampton
Kordo Saeed
- Not yet recruiting
NHS Forth Valley
Stirling
Elan Tsarfati
- Not yet recruiting
University Hospitals of North Midlands
Stoke
Krishna Banavathi
- Recruiting
Swansea Bay University Health Board
Swansea
Brendan Healy
New Zealand11 sites, 11 recruiting
- Recruiting
Starship Hospital
Auckland, 1023
Rachel Webb
- Recruiting
KidzFirst
Auckland, 2025
Rachel Webb
- Recruiting
Hutt Valley Hospital
Boulcott, Lower Hutt, 5010
Matthew Kelly
- Not yet recruiting
Christchurch Hospital
Christchurch, Canterbury, 8011
Sarah Metcalf
- Recruiting
Auckland City Hospital
Grafton, Auckland, 1023
Mark Hobbs
- Recruiting
Waikato Hospital
Hamilton, 3240
Paul Huggan
- Recruiting
Wellington Hospital
Newtown, Wellington Region, 6021
Max Bloomfield
- Recruiting
Middlemore Hospital
Otahuhu, Auckland, 1640
Genevieve Walls
Rachel Webb
- Recruiting
North Shore Hospital
Takapuna, Auckland, 0620
Nick Gow
- Recruiting
Tauranga Hospital
Tauranga, 3112
Kate Grimwade
- Not yet recruiting
Whangarei Hospital
Whangarei, 0148
David Hammer
Netherlands9 sites, 7 recruiting
- Recruiting
Jeroen Bosch Hospital
's-Hertogenbosch
Thijs ten Doesschate
- Active, not recruiting
Rijnstate Hospital
Arnhem
- Recruiting
Treant Ziekenhuis
Emmen
Sander van Assen
- Active, not recruiting
UMC Groningen
Groningen
- Recruiting
Maastricht UMC+
Maastricht
Astrid Oude Lashof
- Recruiting
Antonius Ziekenhuis
Nieuwegein
Bas Weijer
- Recruiting
Radboud University Medical Center
Nijmegen
Nynke Jager
- Recruiting
Ikazia Ziekenhuis
Rotterdam
Felix de Jongh
- Recruiting
University Medical Center Utrecht
Utrecht
Marjolein Hensgens
Germany4 sites, 4 recruiting
- Recruiting
Charité University Hospital Berlin
Berlin
Miriam Stegemann
- Recruiting
University Hospital Carl Gustav Carus Dresden
Dresden
Katja de With
- Recruiting
University Medical Centre Freiburg
Freiburg im Breisgau
Siegbert Richard Rieg
- Recruiting
Otto-von-Guericke-university Magdeburg
Magdeburg
Achim Kaasch
Israel4 sites, 4 recruiting
- Recruiting
Rambam Health Care Campus
Haifa, 310960
Mical Paul
- Recruiting
Beilinson Hospital
Petah Tikva, 49100
Noa Eliakim-Raz
- Recruiting
Schneider Hospital
Petah Tikva
Oded Scheureman
- Recruiting
Sheba Medical Centre
Ramat Gan, 49100
Dafna Yahav
Singapore3 sites, 3 recruiting
- Recruiting
National University Hospital
Singapore, 119228
Sophia Archuleta
- Recruiting
Singapore General Hospital
Singapore, 168753
Shirin Kalimuddin
- Recruiting
Tan Tock Seng Hospital
Singapore, 308433
David Lye
South Africa3 sites, 2 recruiting
- Not yet recruiting
Charlotte Maxeke Johannesburg Academic Hospital
Johannesburg
- Active, not recruiting
Helen Joseph Hospital
Johannesburg
- Not yet recruiting
Rahima Moosa Mother and Child Hospital
Johannesburg
Sweden2 sites, 2 recruiting
- Recruiting
Helsingborg Hospital
Helsingborg
Jonas Tverring
- Recruiting
SUS Malmö
Malmö
Maria Josephson
United States1 site, 1 recruiting
- Recruiting
Houston Methodist Research Institute
Houston, Texas, 77030
Cesar Arias, 346-651-8674, caarias@houstonmethodist.org
France1 site, 1 recruiting
- Recruiting
CHU de Rennes - Hôpital Pontchaillou
Rennes
David Luque Paz
Japan1 site, 1 recruiting
- Recruiting
Science Tokyo University Hospital
Ichikawa, Chiba, 272-0827
Principal Investigator Yoshiaki Gu
About this study
The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is an International Multi-Centered Randomised Adaptive Platform Clinical Trial to evaluate a range of interventions to reduce mortality for patients with Staphylococcus Aureus bacteraemia (SAB).
Read the detailed description
Infection of the bloodstream with the bacterium Staphylococcus aureus (Staphylococcus aureus bacteraemia, SAB) is a serious infection that results in 15-30% of affected patients dying within three months of acquiring the infection. Treatment of this infection requires patients to be hospitalised, treated with prolonged antibiotics through an intravenous line, and carefully examined for the occurrence of complications associated with this condition. At present, there are many treatment options in current use, with no clear agreement as to which of these is best. The SNAP trial aims to identify which treatment options for SAB results in the fewest patients dying within the first 90 days after an infection.
In contrast to a conventional clinical trial, the SNAP trial will examine multiple different treatment options at once. Patients will be randomly assigned to different concurrent treatment options currently considered acceptable in routine medical care, but as the trial progresses, more patients will be assigned to treatments that appear to have better outcomes than those with worse outcomes. The trial will adapt to accumulating trial evidence, on a regular basis, by removing treatment options found to be inferior, incorporating new treatment options, and ensuring that all patients in the trial receive the best treatments once they have been identified. Over time, we hope to determine the best combination of treatment options for patients with SAB.
The SNAP Trial infrastructure will also support a number of sub-studies. A list of all active sub-studies can be found on the SNAP website: https://www.snaptrial.com.au/substudies.
- Conditions
- Staphylococcus Aureus Bacteremia
- Being tested
- Cefazolin, Penicillin, Clindamycin, Vancomycin, Effectiveness of early switch to oral antibiotics
- Keywords
- Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-susceptible Staphylococcus aureus (MSSA), Penicillin-susceptible Staphylococcus aureus (PSSA), Staphylococcus aureus, S. aureus, Staph Aureus Bacteremia (SAB)
- Medical subject headings
- Staphylococcal Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CefazolinDrug
Cefazolin
PenicillinDrug
Also called Benzylpenicillin, Penicillin G
benzylpenicillin
ClindamycinDrug
Also called Lincomycin
Clindamycin
VancomycinDrug
Also called Daptomycin
Vancomycin or Daptomycin
Effectiveness of early switch to oral antibioticsOther
This involves testing a strategy rather than individual antibiotic agents
Whole body FDG PET/CT ImagingRadiation
Whole body FDG PET/CT imaging will be performed using a standardised protocol describing patient preparation and minimum specifications for radiopharmaceutical production, quality control, and PET/CT acquisition.
| Study group | Role | What they receive |
|---|---|---|
| Methicillin-resistant staphylococcus aureus (MRSA) - Standard Therapy Arm (backbone therapy) | No intervention | Vancomycin or Daptomycin - Standard Therapy Arm Either intravenous vancomycin dosed as per Australian Therapeutic Guidelines: This includes a loading dose of 25 mg/kg (up to 3000mg) if considered appropriate by the treating clinician, initial maintenance dosing at 15-20 mg/kg q12h, with subsequent adjustment to maintain area under the concentration-time curve (AUC) of 400 to 600 mg.hr/L OR trough levels at 10-20 mg/L, and the initial level taken 48-72 hours after the initiation of the first dose. Daptomycin 8-10mg/kg per day intravenously. The choice of vancomycin or daptomycin will be at the clinician's discretion. Dosing will be based on renal function. |
| Methicillin-resistant staphylococcus aureus (MRSA) - Standard + B-Lactam Arm (backbone therapy) | Experimental | Vancomycin or Daptomycin (Standard Therapy) + Beta-Lactam (β-lactam) Arm
In addition to standard treatment an intravenous β-lactam will be added for the first 7 calendar days following randomisation (day 1 being the day of randomisation - hence patients will receive 6-7 days of β-lactam). This β-lactam will be intravenous cefazolin 2g every 8 hours. For patients with renal impairment the intravenous cefazolin administration doses will be adjusted. Receives: Drug: Cefazolin; Drug: Vancomycin |
| Methicillin-susceptible staphylococcus aureus (MSSA) - Standard Therapy Arm (backbone therapy) | No intervention | Flucloxacillin or cloxacillin - Standard Therapy Arm Either intravenous flucloxacillin/cloxacillin 2g every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous flucloxacillin administration dose will be adjusted. |
| Methicillin-susceptible staphylococcus aureus (MSSA) - Interventional Arm (backbone therapy) | Experimental | Cefazolin - Interventional Arm
Intravenous cefazolin 2g every 6 or 8 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous cefazolin administration dose will be adjusted. Receives: Drug: Cefazolin |
| Penicillin-susceptible staphylococcus aureus (PSSA) - Standard Therapy Arm (backbone therapy) | No intervention | Flucloxacillin or cloxacillin - Standard Therapy Arm Either intravenous flucloxacillin/cloxacillin 2g every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous flucloxacillin administration dose will be adjusted. |
| Penicillin-susceptible staphylococcus aureus (PSSA) - Interventional Arm (backbone therapy) | Experimental | Benzylpenicillin - Interventional Arm
Intravenous benzylpenicillin 1.8g (3 million units) every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with critical illness the intravenous benzylpenicillin administration doses will be adjusted. Receives: Drug: Penicillin |
| No adjunctive treatment in combination with MRSA or MSSA or PSSA backbone therapy arm | No intervention | No adjunctive therapy + backbone therapy arm for MRSA or MSSA or PSSA Participants with either MRSA or MSSA or PSSA will have no adjunctive therapy in combination with their backbone therapy arm. |
| Adjunctive treatment in combination with MRSA or MSSA or PSSA backbone therapy arm | Experimental | Adjunctive therapy + backbone therapy arm for MRSA or MSSA or PSSA Intravenous clindamycin (or lincomycin) 600mg every 8 hours from platform day 1 to day 5. No dosage adjustment is needed to renal impairment. Receives: Drug: Clindamycin |
| Continue intravenous antibiotic therapies (backbone +/- adjunctive therapy) - standard of care arm | No intervention | Backbone therapy arm for MRSA or MSSA or PSSA +/- adjunctive therapy will continue on intravenous antibiotic treatment for the length of time as per usual standard of care. Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised if not eligible then eligibility will be assess again at Day 14(+/- 2 days). If eligibility is not met at day 14 then participant is excluded from this domain. |
| Switch to oral antibiotics at trial day 7 (+/- 2 days) or Day 14 (+/- 2 days) if eligible. | Experimental | Switch from intravenous backbone antibiotic for MRSA or MSSA or PSSA to oral antibiotics at the treating clinicians discretion on trial Day 7 (+/- 2 days) or trial Day 14 (+/- 2 days).
Participants eligibility is assessed at Day 7 (+/- 2 days). If eligible will be randomised, if not eligible then eligibility will be assessed again at Day 14 (+/- 2 days). If eligibility is not met at day 14 then participant is excluded from this domain. Receives: Other: Effectiveness of early switch to oral antibiotics |
| No PET/CT scan - standard of care arm | No intervention | Participants will not receive a PET/CT scan, in addition to their allocated treatment interventions. Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised. If eligibility is not met then participant is excluded from this domain. |
| PET/CT scan at trial day 7 (+/- 2 days) if eligible | Experimental | Participant will receive a PET/CT scan at Day 5-12, in addition to their allocated treatment interventions.
Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised. If eligibility is not met then participant is excluded from this domain. Receives: Radiation: Whole body FDG PET/CT Imaging |
What is being measured
The primary outcome is the main question the study is designed to answer.
All-cause mortality at 90 days after platform entry
The primary endpoint for all cells and domains will be all-cause mortality at 90 days after platform entry.
The primary endpoint will be determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.
Measured: From randomisation (day 1) until day 90
Secondary outcomes (15)
Core1: All-cause mortality at 14, 28 and 42 days after platform entry
Determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.
Measured: From randomisation (day 1) until day 14, 28, and 42
Core2: Duration of survival censored at 90 days after platform entry
Determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.
Measured: From randomisation (day 1) until day 90
Core3: Length of stay of acute index inpatient hospitalisation for those surviving until discharge from acute inpatient facilities (excluding HITH/COPAT/OPAT/rehab).
Acute index hospitalisation is defined as continuous hospital admission to one or more acute inpatient facilities for the index episode. This does not include HITH/OPAT/COPAT and stepdown inpatient rehabilitation/post-acute care. It does include admission to acute care hospitals immediately preceding and following those at the enrolling site.
Measured: From randomisation (day 1) until discharge from acute inpatient facilities, truncated at 90 days.
Core4: Length of stay of total index hospitalisation for those surviving until hospital discharge (including HITH/COPAT/OPAT/rehab)
Total index hospitalisation is defined as continuous hospital admission to one or more inpatient facilities for the index episode, including HITH/OPAT/COPAT and stepdown inpatient rehabilitation/post-acute care (if continuous with the initial inpatient admission).
It includes admission to acute care hospitals immediately preceding and following those at the enrolling site.
Measured: From randomisation (day 1) to discharge from total index hospitalisation, truncated at 90 days
Core5: Time to being discharged alive from the total index hospitalisation (including HITH/COPAT/OPAT/rehab) truncated at 90 days after platform entry
and all deaths within 90 days will be considered '90 days'
Measured: From randomisation (day 1) to discharge from total index hospitalisation, truncated at 90 days
Core6: Microbiological treatment failure defined as positive sterile site culture for S. aureus [of the same silo as the index isolate between 14 and 90 days after platform entry).
A sterile site means any sites deep to the skin and skin structures, including deep visceral and musculoskeletal abscesses that have been obtained in a sterile manner.
Measured: From day 14 until day 90
Core7: Diagnosis of new foci between 14 and 90 days after platform entry.
The presence of new foci will be determined by the site investigator and can incorporate clinical, radiological, microbiological and pathological findings.
Measured: From day 14 until day 90
Core8: C. difficile diarrhoea as determined by a clinical laboratory in the 90 days following platform entry for participants ≥2 years of age.
This means a stool submitted to a clinical laboratory has tested positive for C. difficile toxin or toxin gene.
Measured: From randomisation (day 1) until day 90
Core9: Serious adverse reactions (SARs) in the 90 days following platform entry
SARs defined only as serious events that are attributable to one or more randomised study interventions
Measured: From randomisation (day 1) until day 90
Core10: Health economic costs as detailed in the health ecnomics appendix.
Including hospital length of stay, readmissions, and patient employment status.
Measured: From randomisation (day 1) until day 90
Core11: Proportion of participants who have returned to their usual level of function at day 90.
Determined by whether the modified functional bloodstream infection score (FBIS) remained the same or improved between baseline and 90 days after platform entry where baseline=best score within the 4 weeks prior to platform entry.
Measured: From randomisation (day 1) until day 90
Core12: Desirability of outcome ranking 1 (DOOR1; modified Antibiotic Resistance Leadership Group version)
See Core Protocol; unable to insert DOOR1 table
Measured: From randomisation (day 1) until day 90
Core13: Desirability of outcome ranking 2 (DOOR2; SNAP version)
See Core Protocol; unable to insert DOOR2 table
Measured: From randomisation (day 1) until day 90
Core14: Total number of antibiotic days (IV and/or oral/enteral) in the 90 days following platform entry.
All antibiotics should be included, not only those intended for treatment of S. aureus bacteraemia. It also includes prophylactic dose antibiotics (e.g., prophylactic dose trimethoprim-sulfamethoxazole).
All days on which any antibiotic dose is received should be counted - i.e. we are counting the number of whole or part days on which any antibiotics are received (not the number of defined daily doses of antibiotics).
Topical, inhaled or other routes of administration besides IV or oral/enteral should not be counted.
Measured: From randomisation (day 1) until day 90
Core15: Days alive and free of antibiotics in the 90 days following platform entry.
All antibiotics should be included, not only those intended for treatment of S. aureus bacteraemia. It also includes prophylactic dose antibiotics (e.g., prophylactic dose trimethoprim-sulfamethoxazole).
All days on which any antibiotic dose is received should be counted - i.e. we are counting the number of whole or part days on which any antibiotics are received (not the number of defined daily doses of antibiotics).
Topical, inhaled or other routes of administration besides IV or oral/enteral should not be counted.
Measured: From randomisation (day 1) until day 90
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Nov 2021
- Study start16 Feb 2022
- Primary completion1 Dec 2028 (estimated)
- Study completion1 Dec 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Staphylococcus Aureus BacteremiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Model description
- Participants enrolled into the study have the option of deciding whether to be randomised in one or more (if available) treatment domains concurrently, if they meet the eligibility criteria.
- Masking
- None (open label)
- Enrolment
- 8,000 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Melbourne
- Sponsor type
- University, hospital or other
- Collaborators
- Berry Consultants, McGill University Health Centre/Research Institute of the McGill University Health Centre, Menzies School of Health Research, Aotearoa Clinical Trials, Queensland University of Technology, Sunnybrook Health Sciences Centre, Tan Tock Seng Hospital, Telethon Kids Institute, The Peter Doherty Institute for Infection and Immunity, The University of Queensland, UMC Utrecht, Radboud University Medical Center, King's College London, Rambam Health Care Campus, University College, London, The Methodist Hospital Research Institute
- Responsible party
- Sponsor
- Investigators
- Prof Steven Tong, Study chair, University of Melbourne / Melbourne HealthProf Joshua Davies, Study chair, Menzies School of Research / Hunter New England Medical Centre
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05137119
- Sponsor's protocol ID
- CT19029
- Acronym
- SNAP
- Status last verified
- Jul 2025
- First submitted
- 25 Apr 2021
- Last updated
- 6 May 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified patient data
Publications
Tong SYC, Mora J, Bowen AC, Cheng MP, Daneman N, Goodman AL, Heriot GS, Lee TC, Lewis RJ, Lye DC, Mahar RK, Marsh J, McGlothlin A, McQuilten Z, Morpeth SC, Paterson DL, Price DJ, Roberts JA, Robinson JO, van Hal SJ, Walls G, Webb SA, Whiteway L, Yahav D, Davis JS; Staphylococcus aureus Network Adaptive Platform (SNAP) Study Group. The Staphylococcus aureus Network Adaptive Platform Trial Protocol: New Tools for an Old Foe. Clin Infect Dis. 2022 Nov 30;75(11):2027-2034. doi: 10.1093/cid/ciac476.
PubMed 35717634Symons TJ, Straiton N, Gagnon R, Littleford R, Campbell AJ, Bowen AC, Stewart AG, Tong SYC, Davis JS. Consumer perspectives on simplified, layered consent for a low risk, but complex pragmatic trial. Trials. 2022 Dec 28;23(1):1055. doi: 10.1186/s13063-022-07023-z.
PubMed 36578070Malhame I, Hardy E, Cheng MP, Tong SY, Bowen AC. Walking the walk to include pregnant participants in non-obstetric clinical trials: Insights from the SNAP Trial. Obstet Med. 2023 Mar;16(1):3-4. doi: 10.1177/1753495X231163351. Epub 2023 Mar 22. No abstract available.
PubMed 37139509Henderson A, Cheng MP, Chew KL, Coombs GW, Davis JS, Grant JM, Gregson D, Giulieri SG, Howden BP, Lee TC, Nguyen V, Mora JM, Morpeth SC, Robinson JO, Tong SYC, Van Hal SJ; Microbiology Working Group of the Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group. A multi-site, international laboratory study to assess the performance of penicillin susceptibility testing of Staphylococcus aureus. J Antimicrob Chemother. 2023 Jun 1;78(6):1499-1504. doi: 10.1093/jac/dkad116.
PubMed 37071589de Kretser D, Mora J, Bloomfield M, Campbell A, Cheng MP, Guy S, Hensgens M, Kalimuddin S, Lee TC, Legg A, Mahar RK, Marks M, Marsh J, McGlothin A, Morpeth SC, Sud A, Ten Oever J, Yahav D, Bonten M, Bowen AC, Daneman N, van Hal SJ, Heriot GS, Lewis RJ, Lye DC, McQuilten Z, Paterson DL, Owen Robinson J, Roberts JA, Scarborough M, Webb SA, Whiteway L, Tong SYC, Davis JS, Walls G, Goodman AL; SNAP Early Oral Switch Domain-Specific Working Group and SNAP Global Trial Steering Committee; SNAP Trial Group. Early Oral Antibiotic Switch in Staphylococcus aureus Bacteraemia: The Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol. Clin Infect Dis. 2024 Oct 15;79(4):871-887. doi: 10.1093/cid/ciad666.
PubMed 37921609Mahar RK, McGlothlin A, Dymock M, Lee TC, Lewis RJ, Lumley T, Mora J, Price DJ, Saville BR, Snelling T, Turner R, Webb SA, Davis JS, Tong SYC, Marsh JA; SNAP Global Trial Steering Committee. A blueprint for a multi-disease, multi-domain Bayesian adaptive platform trial incorporating adult and paediatric subgroups: the Staphylococcus aureus Network Adaptive Platform trial. Trials. 2023 Dec 6;24(1):795. doi: 10.1186/s13063-023-07718-x.
PubMed 38057927Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group. Benzylpenicillin versus flucloxacillin or cloxacillin for the treatment of penicillin-susceptible Staphylococcus aureus bacteraemia (SNAP): an international, multicentre, open-label, non-inferiority randomised controlled trial. Lancet. 2026 Jul 11;408(10550):141-152. doi: 10.1016/S0140-6736(26)00761-0. Epub 2026 Jun 17.
PubMed 42309115Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group; Lee TC, Barina LA, Walls G, Goodman AL, Yahav D, Cheng MP, Bonten M, Bowen AC, Boyles T, Daneman N, Ekkelenkamp MB, Ghanem-Zoubi N, Hensgens MPM, Jager NGL, Kaasch AJ, Kouijzer IJE, Lewis RJ, Lumley T, Lye DC, McDonald EG, McKew G, McLean ARD, McMullan BJ, McQuilten ZK, Morpeth SC, Paterson DL, Roberts JA, Robinson JO, Saito H, Scarborough M, Ten Oever J, Turner RM, Tverring J, van Hal SJ, Webb SA, Whiteway LM, Arias CA, Henderson A, Heriot GS, Snelling TL, Afra K, Ali SS, Amit S, Anagnostou NA, Archuleta S, Aston SJ, Athan E, Baharav N, Bai AD, Barber BE, Baskaran A, Berkeley MMA, Best EJ, Bhilave NR, Bloomfield MG, Bond KA, Bostock J, Botheras CL, Boyd MA, Bradshaw SME, Briggs EJ, Britton PN, Campbell AJ, Carr BZ, Chancellor JA, Chen K, Cheong EY, Chew KL, Chia PY, Chomba R, Chong BSW, Clews CJN, Cohen JM, Commons RJ, Cutfield T, Daley P, Daniel DS, Davies J, De P, Denholm JT, Di Virgilio M, Dishon-Benattar Y, Dotel R, Duan EH, Easom N, Eliakim-Raz N, England MM, Fahmy M, Findlater AR, Flanagan KL, Foo EZJ, Foo H, Forster DP, Fralick M, Frazer JL, Gador-Whyte AP, Garnham K, German GJ, Ghosh N, Gisolf EH, Giulieri SG, Goulding SR, Grant JM, Gregson D, Grimwade KC, Grupper M, Guy SD, Gwee A, Hall VG, Hardy EJ, Harris DJ, Hatcher J, Hobbs MR, Holmes NE, Howden BP, Huggan PJ, Jennings ZA, Johnstone J, Juniper T, Kalimuddin S, Kamfose M, Kandel C, Kelly MJ, Kozak RA, Kumin M, Lamontagne F, Lau JSY, Lee IR, Lin RJ, Lindsay D, Llewelyn MJ, Longtin Y, Lother SA, Luey CE, MacFadden DR, Mahony AA, Malden C, Malhame I, Manning LA, Marks M, Martin LJ, Matthews GV, McGann PH, McMahon JH, Melon A, Menon V, Mertz D, Meyer MP, Molton JS, Mora JM, Moran E, Mortimer LM, Motaganahalli S, Muller MP, Munro APS, Murray FA, Murthy S, Nagendra V, Nel H, New DWJ, Nguyen V, Norton G, Norton KM, Nourse CB, Nye CJS, O'Callaghan K, O'Sullivan MVN, Ong SWX, Otu AA, Owen M, Papenburg J, Parkes LO, Paul M, Perez-Patrigeon S, Petersiel N, Petrella L, Pett SL, Pham D, Piazzese CJ, Poulin S, Rehak R, Rennert-May E, Richards AJ, Rogers BA, Sahng E, Salada B, Scheuerman O, Schneider K, Schulz TR, Schwartz KL, Simos PA, Singh H, Sinkeler FS, Smith S, Smith BJ, Smith SW, Somayaji R, Sommerville C, Song RXJ, Sowden DC, Stark MJ, Stone NRH, Strunk T, Sud A, Swe KP, Symons CR, Tan YE, Ten Doesschate T, Thien SY, Thomas A, Trad MA, Tramontana AR, Tsang JLY, Ulett K, Underwood J, van Welzen BJ, Vazquez-Grande G, Velasquez Reyes DC, Verberk JDM, Voss LM, Ward D, Webb RH, Whitmore TJ, Wieder-Finesod A, Wilson HL, Wilson EW, Wong HM, Wong She K, Wuerz T, Yamamura DL, Yeoh A, Yow BLH, Dymock M, Mahar RK, McGlothlin A, Marsh JA, Davis JS, Tong SYC. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia. N Engl J Med. 2026 Jun 18;394(23):2329-2339. doi: 10.1056/NEJMoa2506905.
PubMed 42308484Shah S, Clarke LG, Falcione BA, Shields RK, Smith BJ. Incidence and factors associated with rapid blood culture sterilization among patients receiving ertapenem combination therapy for MSSA bacteremia. Antimicrob Agents Chemother. 2026 Feb 4;70(2):e0130325. doi: 10.1128/aac.01303-25. Epub 2025 Dec 23.
PubMed 41433510Mahar RK, McGlothlin A, Dymock M, Barina L, Bonten M, Bowen A, Cheng MP, Daneman N, Goodman AL, Lee TC, Lewis RJ, Lumley T, McLean ARD, McQuilten Z, Mora J, Paterson DL, Price DJ, Roberts J, Snelling T, Tverring J, Webb SA, Yahav D, Davis JS, Tong SYC, Marsh JA; SNAP Global Trial Steering Committee. Statistical documentation for multi-disease, multi-domain platform trials: our experience with the Staphylococcus aureus Network Adaptive Platform trial. Trials. 2025 Feb 11;26(1):49. doi: 10.1186/s13063-024-08684-8.
PubMed 39934879