An Audit of Staphylococcus aureus Bacteraemia Treatment in a UK District General Hospital

Objective: Recent guidelines from Healthcare Improvement Scotland recommend that uncomplicated Staphylococcus aureus bacteraemia (SAB) be treated with effective antibiotics for at least 14 days.  This audit aimed to see whether Medway Hospital, UK, was following these guidelines, and whether a simple intervention could improve compliance and therefore treatment. Method: All patients with SAB between April 2013 and September 2014 were identified and their clinical notes, laboratory findings and drug charts were reviewed. Starting in January 2014 all SAB were reported on the online pathology results system with the following advice; ‘Staphylococcus aureus bacteraemia warrants a minimum of 14 days treatment. Treatment may be longer in cases of deep seated infection.’ Outcome measures included 14 days antimicrobial treatment readmission rate with SAB, 3 month mortality post treatment and whether echocardiography was performed. Results: The demographics of all patients (35 pre and 39 post intervention) were comparable between groups (average age 63 vs 56, 54.3% vs 69.2% male) although the sources of bacteraemia differed slightly. More patients had indwelling lines in 2013 and there were a higher proportion of IV drug users in 2014; all other risk factors were similar between groups. More patients received appropriate antibiotics post intervention (74% vs 49%). Three month mortality with community acquired SAB increased but mortality with hospital acquired SAB decreased post intervention. Echocardiography uptake improved, and readmission rates with SAB decreased. Conclusion: The introduction of guidance with blood culture results has demonstrated better compliance with a 14 day minimum treatment length for SAB.  Although sample size limits obtaining a statistically significant difference in readmission and mortality rates, this intervention still has the potential to improve treatment of SAB in aiding clinicians to follow guidelines. J Microbiol Infect Dis 2017; 7(4):188-193