Category Bloodstream

Is combination therapy with rifampicin for S. aureus bacteraemia a good idea? – highlight from Vienna

Guest posting: Dr Patrick Harris, our roving correspondent at the European Congress on Clinical Microbiology and Infectious Diseases (ECCMID) Conference in Vienna.  At last, an RCT tells us the answer… For many years the evidence-base for things we do routinely in infectious disease has been somewhat sketchy. We are often forced to formulate our recommendations […]

Micro lab comments: candidaemia and candiduria

Candidal bloodstream infection represents a high risk infection, even for immunocompetent patients. Mortality is significant even for IV line-associated candidaemia.  Blood cultures are seldom contaminated by fungi and any patient with an isolate must be subjected to careful clinical assessment. Our comment serves to give a few reminders that follow on from the liaison between the […]

Microlab comment: beta-haemolytic streptococci isolated from blood

Here is another one used for uncomplicated bloodstream infection events: Infections due to these species of streptococci are usually rapidly responsive to appropriate antibiotic therapy which can be of short duration with no minimum IV requirement as endocarditis is not a usual consideration.  Penicillin resistance has not been documented and flucloxacillin is just as active (see […]

Micro comments unpacked: Gram negative bacteraemia

Here is an example comment from Pathology North which is added to positive blood culture reports when a Gram negative coliform species ( Enterobacteriacae eg. E. coli) has been isolated: The comment’s rationale is to promote short course treatment and also to prompt oral antibiotic switching in a timely manner.  It also prompts consideration of source […]

Fatal case of meningococcal infection – a salutary tale

This unfortunate 27 year old pregnant woman collapsed at home with a seizure and then died soon after.  She had a disseminated W135 serotype infection – this serotype has been associated with a number of recent severe cases in Hunter New England.  Neisseria meningitidis case presentation Dr Rexson Tse May 2016 Perhaps there were no preventable […]

AHA infective endocarditis treatment guideline for adults 2015

These American Heart Association recommendations (free online availability) update the 2005 version and continue to incorporate an evidence-based scoring system for all recommendations. Recommendations on diagnosis and on use of echocardiography remain essentially unchanged. Additional information is provided on the therapeutic principles of antimicrobial treatment, including treatment duration and recommendations for specific pathogens. Note that in Australia, […]

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 […]

Maximising the value of blood cultures

Blood cultures give a critically important window on bacterial and fungal sepsis, providing direct patient treatment guidance and reliable antimicrobial susceptibility data that are used to construct cumulative antibiograms and empirical treatment guidelines.  They also help to rule out serious bacterial infection, provided that collection occurs prior to antibiotic treatment and an adequate patient sample is taken. Here […]

Choosing Wisely: Antibiotic prophylaxis for prevention of infective endocarditis

For many years, antibiotic prophylaxis was routinely administered before dental and other procedures to patients with cardiac conditions that carry a high lifetime risk of infective endocarditis. However due to the infrequent occurrence of endocarditis, prophylaxis prevents very few cases. Infective endocarditis is more likely to result from bacteraemia associated with daily activities (e.g. tooth […]