OBJECTIVE: Bacteraemia caused by Staphylococcus aureus (SA bacteraemia) can run a relatively mild course, but can also be complicated by focal infections in bones, joints, soft tissue and the heart. The Infectious Disease Society of America (IDSA) advises a transoesophageal echocardiogram (TOE) be taken in each case of SA bacteraemia in order to rule out endocarditis, in addition to sampling blood for culture 2-3 days after the start of treatment. Both the IDSA and the Dutch Stichting Werkgroep Antibiotica Beleid (SWAB - Foundation for Antibiotic Policy Work Groups) recommend that patients with SA bacteraemia be treated intravenously for at least 14 days; longer if a complicated course is expected. We investigated whether SA bacteraemia was diagnosed and treated according to current guidelines. DESIGN: Retrospective cohort study METHOD: A case series of consecutive patients ≥ 18 years of age with SA bacteraemia was identified using the electronic microbiology registration system. RESULTS: A total of 93 patients were identified. Median follow-up duration was ≥ 3 months. Of the 81 patients who had survived one week after admission to the hospital, 41(60%) did not undergo TOE. Blood cultures on day 3 were performed in only 6 (6%) patients. Of the 79 (85%) patients who had survived the first two weeks of infection, 26 (33%) had been treated with intravenous antibiotics for less than 14 days. Recurrent SA bacteraemia occurred in 4 patients. CONCLUSION: In the majority of patients with SA bacteraemia, diagnostic work-up and duration of therapy did not comply with ISDA and SWAB guidelines.
OBJECTIVE:Bacteraemia caused by Staphylococcus aureus (SAbacteraemia) can run a relatively mild course, but can also be complicated by focal infections in bones, joints, soft tissue and the heart. The Infectious Disease Society of America (IDSA) advises a transoesophageal echocardiogram (TOE) be taken in each case of SAbacteraemia in order to rule out endocarditis, in addition to sampling blood for culture 2-3 days after the start of treatment. Both the IDSA and the Dutch Stichting Werkgroep Antibiotica Beleid (SWAB - Foundation for Antibiotic Policy Work Groups) recommend that patients with SAbacteraemia be treated intravenously for at least 14 days; longer if a complicated course is expected. We investigated whether SAbacteraemia was diagnosed and treated according to current guidelines. DESIGN: Retrospective cohort study METHOD: A case series of consecutive patients ≥ 18 years of age with SAbacteraemia was identified using the electronic microbiology registration system. RESULTS: A total of 93 patients were identified. Median follow-up duration was ≥ 3 months. Of the 81 patients who had survived one week after admission to the hospital, 41(60%) did not undergo TOE. Blood cultures on day 3 were performed in only 6 (6%) patients. Of the 79 (85%) patients who had survived the first two weeks of infection, 26 (33%) had been treated with intravenous antibiotics for less than 14 days. Recurrent SAbacteraemia occurred in 4 patients. CONCLUSION: In the majority of patients with SAbacteraemia, diagnostic work-up and duration of therapy did not comply with ISDA and SWAB guidelines.
Authors: Maud B P A Ariaans; Elisabeth A Roovers; Mark A A Claassen; Robert-Jan Hassing; Caroline M A Swanink; Elisabeth H Gisolf Journal: Eur J Clin Microbiol Infect Dis Date: 2018-04-18 Impact factor: 3.267