Evaluation of diagnosis and therapy of Staphylococcus aureus bacteraemia: recommended minimum treatment duration of 2 weeks not always met
Landman, G.W.D.; Bouwhuis, J.W.; Bloembergen, P.; van der Meer, J.T.M.; Groeneveld, P.H.P.
Nederlands Tijdschrift Voor Geneeskunde 155(38): A3376
2011
ISSN/ISBN: 1876-8784 PMID: 21939568 Document Number: 650240
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. Retrospective cohort study A case series of consecutive patients ≥ 18 years of age with SA bacteraemia was identified using the electronic microbiology registration system. 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. In the majority of patients with SA bacteraemia, diagnostic work-up and duration of therapy did not comply with ISDA and SWAB guidelines.