Evaluation of clinical guidelines for the management of Staphylococcus aureus bacteraemia

Background: While treatment guidelines have been developed to guide the management of Staphylococcus aureus bacteraemia, there is a need to validate these guidelines in different clinical settings and to relate the effect of compliance to clinical outcome. Aims: To assess the impact of adherence to treatment guidelines on clinical outcome and to explore the role of transoesophageal echo cardiography (TOE) in risk stratification. Methods: We under-took a 2-year mixed retrospective and prospective study of all cases of S. aureus bacteraemia at Fremantle Hospital, documenting the clinical and microbiological features of each case, the results of echocardiography, adherence with published clinical guidelines and clinical outcome. Results: Failure to comply with guidelines was observed in 41% (38 of 93) of cases, the majority receiving abbreviated treatment. An increased rate of relapse was observed among patients who received inadequate therapy (5/38 vs 1/55; P = 0.04). Ten of 28 eligible patients underwent TOE and the test led to significant changes in management in two of those cases. Conclusions: While non-adherence with clinical guidelines was associated with an increased risk of relapse, the role of TOE in risk stratification was limited by factors including cost, limited acceptance of the test and the need for prolonged therapy for other indications.