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.
Pathology North blood culture reports include the following guidance comments
Methicillin-susceptible (MSSA) SAB: