HNELHD_CG_23_44_Staphylococcus_aureus_bacteraemia_Mgmt

Key clinical care required for all patients with SAB

1. Commence intravenous (IV) high dose flucloxacillin AND vancomycin (unless allergies) immediately, pending results of S.aureus PCR testing or susceptibilities.
2. Remove any removable foci of infection (change IV lines, drain abscesses).
3. Evaluate for complicated SAB using the criteria defined below (section 2.3).
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. Progress to trans-oesophageal echocardiogram (TOE) if indicated (section 2.1).
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 (section 2.3)

Provide verbal and written advice to the patient and their family about the symptoms of relapse and the need for early review if problems occur.

N.B. Complicated SAB is defined as the presence of ANY of the following features :
● Persistent bacteraemia at 48-72 hours following initiation of appropriate antibiotics.
● Persistent fever for >72 hours following initiation of appropriate antibiotics.
● Abnormal valvular morphology or evidence of valvular lesions, regurgitation, or endocarditis on a technically adequate echocardiogram.
● No identifiable focus of infection or an identifiable focus that has not been removed (removable foci include intravascular lines, skin and soft tissue abscesses that have been drained and simple skin lesions).
● Metastatic foci (e.g., endocarditis, vertebral osteomyelitis, visceral abscesses).
● Intravascular prosthetic material (e.g., prosthetic cardiac valve, pacing wires, pacemaker, implanted defibrillator, prosthetic arteriovenous graft).

Complicated SAB (adults): Give at least 4 weeks of intravenous therapy; extend to 6 weeks if response to therapy is slow or if indicated by the specific complication.
Complicated SAB (paediatrics): A longer duration of therapy is generally required for complicated infection. Seek expert advice.