Essential clinical care of Staphylococcus aureus bloodstream infection (SAB)

201 cases of SAB were managed across Hunter New England Health last year. The overall 30 day all-cause mortality was 22% (30% in those patients 60 years or above).  Relapse of infection occurs in 2-10% of adult patients and may occur up to 3 months after the original bacteraemia. Relapse rates are reduced but not eliminated by appropriate treatment.

See HNELHD_CG_14_20_Management_of_Staphylococcus_aureus_bacteraemia for detailed advice. 

What to do if your patient has Staphylococcus aureus grown in a blood culture:

1. Commence intravenous (IV) high dose flucloxacillin AND vancomycin (unless allergies) immediately, pending susceptibilities.
2. Remove any removable foci of infection (change IV lines, drain abscesses).
3. Evaluate for complicated SAB using the criteria defined below.
4. Repeat blood cultures between 48-72 hours following the start of treatment.
5. Monitor full blood count (FBC), C-reactive protein (CRP), electrolytes and liver enzymes every 3 days for 2 weeks and then weekly for the duration of IV antibiotic treatment.
6. Arrange trans-thoracic echocardiogram (TTE) in all adults & in children with structural heart disease, clinical suspicion of endocarditis or prolonged bacteraemia on day 5-7 & trans-oesophageal echocardiogram (TOE), if necessary.
7. Except in renal dialysis, arrange or insert a peripherally-inserted central catheter (PICC) line once blood cultures have become negative.
8. Consult the on-call ID Consultant or contact the on-call Clinical Microbiologist for ALL patients with SAB (see About for contact details and personnel)
9. Give your patient 2-6 weeks of intravenous (IV) antibiotics at appropriate dose.
10. Provide verbal & written advice to your patient and their family about the symptoms of relapse and the need for early review if problems occur.  The guideline has a patient information card within.

Capture

Pathology North blood culture reports include the following guidance comments 

Methicillin-susceptible (MSSA) SAB:

Capture

MRSA SAB:

Capture

4 comments

  1. […] and other metastatic complications are extremely rare with these species, contrasting with bacteraemia due to Staphylococcus aureus where prolonged high dose IV therapy is predicated on this […]

    Like

  2. […] for clinicians is laid out in this posting – please read and understand it ; also suggest the clinician accesses it […]

    Like

  3. […] A BSI from S. aureus is a serious problem – patients present from the community or it can be a healthcare-associated event and the mortality at one month can be as high as 30%.   The most important susceptibility to check is whether the isolate is methicillin-susceptible. If it is, then the best antibiotic to use is flucloxacillin (a betalactam that is not destroyed by betalactamase). It is given by the intravenous route at high dose as a proportion of patients already have endocarditis.   For an overview of 10 essential clinical care steps for managing patients with Staph. aureus BSI, see this posting. […]

    Like

  4. […] management approach to Staphylococcus aureus BSI – n.b. 60 events at PMGH in 2016 (40% […]

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: