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Related Documents Therapeutic Guidelines: Antibiotic, Therapeutic Guidelines, Melbourne, Victoria 2006 Portfolio Executive Director responsible Dr Kim Hill Director Clinical Governance for CPG CPG Contact Person Dr John Ferguson , jferguson@hnehealth.nsw.gov.au Distribution Area Director of Pharmacy All Directors of Pharmacy HNE facilities Area Quality Use of Medicines Committee (QUMC) HNE facility/network/service based QUMC or equivalent Medical Staff Council Chairs and associated key medical staff contacts (including DMS) Directors of Junior medical officer and physician training Distributed to individual clinicians by Microbiology when an event occurs. Stakeholders consulted in development HNE Infectious Disease Physicians of CPG Medical Microbiologists (HAPS) Cardiology, John Hunter Hospital Date Authorised by Area Clinical 28 November 2007 Quality and Patient Safety Committee Review Due Date: Nov 2009 TRIM Number:
Executive Summary Staph. aureus is a major cause of community and hospital-associated infection with an attributable mortality around 7-10%1. Overall complication rates are high 24%2. Post treatment relapse of infection due to haematogenous complications occurs in 5-13% of patients (most commonly endocarditis followed by septic arthritis and vertebral osteomyelitis) and may present up to 3 months after the original bacteraemia1,2,3. Relapse rates may be reduced but not eliminated by following the antibiotic, dosage and duration recommendations provided in this guideline. However, late relapse cannot be predicted and may occur even after prolonged initial IV therapy. This CPG describes important aspects of clinical management, indications for Infectious Disease review, recommended investigations and antibiotic selection, dosage and duration. NB. For all paediatric, complex or relapsed cases, liaison Staph. aureus Bacteraemia Management 1 of 5 with Infectious Diseases is recommended.
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Cephalothin
Child 30mg/kg up to 1g 12-hrly Monotherapy is standard. The addition of gentamicin is not shown to improve outcome and is not routinely recommended. * Vancomycin notes: If total calculated dose is greater than 2g/d then give 8-hourly dosing Repeat doses are guided by measured trough level, aiming for trough of 10-20mg/L. In patients with estimated GFR> 50mL/min, check trough prior to 4th dose. In patients with abnormal or changing renal function, measure trough levels frequently so that dosing can be optimised. Advice on vancomycin drug dosing is available via Clinical Microbiology, HAPS (02 49214000).
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Patient Education
All patients with Staph. aureus bacteraemia require education about the risk of relapse and the need for early medical attention for possible symptoms of relapse (see Patient Information Sheet below). Where possible each patient should receive medical review one month after completion of treatment.
MRSA Decolonisation
Patients with MRSA bacteraemia should be considered for a decolonisation procedure- this should be discussed with the Infectious Diseases or Microbiology team who will provide necessary instruction about the methods. Decolonisation may proceed during treatment for bacteraemia, provided that there is no complex infected focus, indwelling medical device or chronic ulcer/wound.
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You were recently diagnosed with a septicaemia (blood infection) caused by the bacterium, Staph. aureus. This infection has been treated with intensive antibiotics. Whilst this usually cures the infection, there is possibility that your infection could return within 3 months following completion of treatment. You are advised to keep watch for any of the following symptoms: - fever, chills, sweats or shakes - headache, nausea, vomiting, lightheadedness - back ache or pain - breathlessness - chest pain If you develop illness that concerns, then please contact your General Practitioner or the Hospital Infectious Diseases Consultant (tel. 49213000) as soon as possible. Your should take this card with you to any medical consultation. Also note that before any antibiotics are given to you, you will need to have blood cultures taken. If you have questions regarding the information provided on this card, then please discuss this with your hospital doctor prior to going home. Date of blood stream infection: Type of Staph.aureus isolated (circle) _______________ MRSA MSSA
References
1. Fowler et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clinical Infectious Diseases 1998;27(3):478-86. 2. Jernigan J, Farr B Short-course therapy of catheter-related Staphylococcus aureus bacteraemia: a meta-analysis. Ann Intern Med. 1993 Aug 15;119(4):304-11. 3. Chang et al. Staphylococcus aureus bacteraemia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore). 2003 Sep;82(5):333-9. 4. Fowler VG Jr, Justice A, Moore C, Benjamin DK Jr, Woods CW, Campbell S, Reller LB, Corey GR, Day NP, Peacock SJ. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. 2005 Mar 1;40(5):695-703.
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