Staphylococcal septicaemia

A41.2

• Description
• Diagnostic criteria
• General and supportive measures
• Medicine treatment
• Referral

DESCRIPTION

Staphylococci cause disease by direct invasion of tissues with liberation of toxins. Septicaemia may occur when haematogenous dissemination occurs from a focus of infection.

DIAGNOSTIC CRITERIA

Clinical

Features of septicaemia should raise an index of suspicion of staphylococcal infection.

Suggestive features of staphylococcal infection include:

• presence of abscesses,
• erythema of palms and soles,
• drip site infections,
• osteomyelitis,
• septic arthritis, and
• endocarditis.

Investigations

• Send pus for culture and sensitivity.
• Blood cultures are frequently negative in serious staphylococcal infection, a finding that highlights the need for performing cultures on other specimens.

GENERAL AND SUPPORTIVE MEASURES

• Surgical drainage or aspiration of pus.
• If infection is associated with a foreign body, such as an intravenous catheter, remove catheter and submit tip for culture and sensitivity.

MEDICINE TREATMENT

When S. aureus isolates are likely to be the cause of infection, the most appropriate agents to administer for empiric treatment are based on the relative frequency of CA-MRSA isolates in the particular community.

Sensitive staphylococcal bacteraemia:

• Cloxacillin, IV, 50 mg/kg/dose 6 hourly for at least 14 days, longer courses often required.

Sensitive staphylococcus (bone and joint)

• Cloxacillin, IV, 50 mg/kg/dose 6 hourly, can transition to oral therapy once there is sustained clinical improvement, resolution of fever and CRP < 30 mg/L.
  • Septic arthritis: 2-4 weeks of treatment.
  • Acute osteomyelitis: 4-6 weeks of treatment.
  • Infective endocarditis: see Chapter: Cardiovascular System, Endocarditis, infective .

Methicillin resistant staphylococci (proven/suspected):

• Vancomycin, IV, 15 mg/kg/dose, 6 hourly infused over 1 hour.
  • Where available, therapeutic drug level monitoring recommended:
    • Check vancomycin trough level within one hour before 4ᵗʰ or 5ᵗʰ dose.
    • Adjust dose to keep trough level within recommended range (severe infections 15-20 mcg/mL, less severe infections 10-15 mcg/mL).

REFERRAL

• Severe sepsis with organ dysfunction.
• Septic shock after resuscitation.
• Staphylococci resistant to above antibiotics.
• Patients requiring debridement of necrotic areas or drainage of collections.