Essential clinical care of Staphylococcus aureus bloodstream infection (SAB)

Updated 8/5/20.

A. Healthcare-associated events (2018, HNE LHD )

60 healthcare-associated SAB cases occurred with 7% due to methicillin-resistant Staphylococcus aureus (MRSA) and age-adjusted 30 day mortality of 9%. SAB relapse within 15-90 days occurred in 2.1% of adult events 7% of paediatric events. Principle sites common:

● Vascular access device (e.g. intravenous cannula, central venous catheter, arterial line,
tunnelled central line, subcutaneous port) – 50%
● Skin and soft tissue infection (e.g. abscess, boil, post-operative wound infection) – 10%
● Primary blood stream infection with no apparent primary source or clear focus – 8%

B. Community-acquired events (2018)

234 community acquired SAB events were documented with 7% due to MRSA and 30 day age-adjusted mortality of 16%. SAB relapse within 15-90 days occurred in 2% SAB adult events and 0% of paediatric events.
• Primary blood stream infection with no apparent primary source or clear focus – 30%
• Skin and soft tissue infection (e.g. abscess, boil, deep abscess) -26%
• Joint infection or spinal osteomyelitis – 16%
• Pneumonia – 6%

Key clinical care required of all patients with SAB

See 2020 version HNELHD_CG_20_08_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 and 72 hours after 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 and in selected children between days 5 and 7.
7. Except in renal dialysis patients, arrange or insert a peripherally-inserted central catheter (PICC) line once blood cultures have become negative.
8. Consult the Infectious Diseases on-call consultant or contact the on-call Clinical Microbiologist for ALL patients with SAB (by phone if necessary – (02) 4921 3000 for ID physician or (02) 4921 4000 for Clinical Microbiologist).
9. Give adult patients 2 to 6 weeks of intravenous (IV) antibiotics
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:

Capture

MRSA SAB:

Capture

6 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 […]

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

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  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. […]

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

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

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  6. Reblogged this on AIMED – Let's talk about antibiotics and commented:

    Updated HNELHD guideline published 2020.

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