Communicable E26: SNAP out of it: Rethinking anti-staphylococcal penicillins for S. aureus bacteremia - the SNAP trial PSSA/MSSA results

In this first-ever collaboration between Communicable and Breakpoints, the podcast of the US Society of Infectious Diseases Pharmacists, hosts Angela Huttner (Geneva, Switzerland) and Erin McCreary (Pittsburgh, USA) join trial investigators Josh Davis (Newcastle, Australia) and Steve Tong (Melbourne, Australia) to unpack the first results coming from the SNAP adaptive platform trial, which were recently presented at ESCMID Global in Vienna. Learn whether penicillin and cefazolin are non-inferior to—and maybe even safer than—flucloxacillin for penicillin-susceptible and methicillin-susceptible Staphylococcus aureus, respectively.

This episode was edited by Julie Anne Justo, transcribed by Katie Lambert and Sarah Groome, and peer-reviewed by Megan Klatt and Lacy Worden.

Note on conflict of interest for SNAP Data Safety Monitoring Committee (DSMC) members:

Conflicts of interest were evaluated when choosing individuals to serve on the SNAP DSMC. Aside from being compensated for their duties on the committee, DSMC members have no ongoing financial relationships that relate to the trial and are not involved in the conduct of the trial in any role other than that of a DSMC member. DSMC members have no intellectual conflict of interest or bias and reviewed SNAP data in a fully objective manner.

Literature:

Steven Y. C. Tong, Joshua S. Davis, Emily Eichenberger et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015 Jul;28(3):603-61.

SNAP Adaptive trial platform/results of the PSSA & MSSA domains:

• https://www.snaptrial.com.au/

ESCMID Global April 2025 presentation:

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

CloCeBa trial results (ESCMID Global April 2025 presentation):

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

Note on access to online video of ESCMID Global presentations:

• In the six months following the congress:
  • Non-ESCMID members have access if they registered for ESCMID Global
  • Members have access only if they registered for ESCMID Global
• Six months after the congress:
  • Non-members do not have access, whatever their ESCMID Global registration status
  • All members have access, whatever their ESCMID Global registration status

CAMERA 2 trial: Steven Y. C. Tong, David C. Lye, Dafna Yahav, et al. Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA BacteremiaA Randomized Clinical Trial. JAMA. 2020;323(6):527-537. doi:10.1001/jama.2020.0103

POET trial: Kasper Iversen, Nikolaj Ihlemann, Sabine U. Gill et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2019;380:415-424

POET trial follow-up: Mia M. Pries-Heje, Christoffer Wiingaard, Nikolaj Ihlemann. Five-Year Outcomes of the Partial Oral Treatment of Endocarditis (POET) Trial. N Engl J Med 2022;386:601-602