The Management of Staphylococcus aureus Bacteremia in the United Kingdom and Vietnam : A Multi-Centre Evaluation

Background: Staphylococcus aureus bacteremia is a common and serious infection worldwide and although treatment guidelines exist, there is little consensus on optimal management. In this study we assessed the variation in management and adherence to treatment guidelines of S. aureus bacteremia. Methodology/Principal Findings: We prospectively recorded baseline clinical characteristics, management, and in-hospital outcome of all adults with S. aureus bacteremia treated consecutively over one year in eight centres in the United Kingdom, three in Vietnam and one in Nepal. 630 adults were treated for S. aureus bacteremia: 549 in the UK (21% methicillinresistant), 80 in Vietnam (19% methicillin-resistant) and 1 in Nepal. In the UK, 41% had a removable infection focus (50% intravenous catheter-related), compared to 12% in Vietnam. Significantly (p,0.001) higher proportions of UK than Vietnamese patients had an echocardiogram (50% versus 28%), received more than 14 days antibiotic therapy (84% versus 44%), and received . 50% of treatment with oral antibiotics alone (25% versus 4%). UK centres varied significantly (p,0.01) in the proportions given oral treatment alone for . 50% of treatment (range 12–40%), in those treated for longer than 28 days (range 13–54%), and in those given combination therapy (range 14–94%). 24% died during admission: older age, time in hospital before bacteremia, and an unidentified infection focus were independent predictors of in-hospital death (p,0.001). Conclusions/Significance: The management of S. aureus bacteremia varies widely between the UK and Vietnam and between centres in the UK with little adherence to published guidelines. Controlled trials defining optimal therapy are urgently required. Citation: Thwaites GE, United Kingdom Clinical Infection Research Group (UKCIRG) (2010) The Management of Staphylococcus aureus Bacteremia in the United Kingdom and Vietnam: A Multi-Centre Evaluation. PLoS ONE 5(12): e14170. doi:10.1371/journal.pone. 0014170 Editor: Mark Patrick Nicol, University of Cape Town, South Africa Received July 21, 2010; Accepted October 14, 2010; Published December 13, 2010 Copyright: 2010 Thwaites, United Kingdom Clinical Infection Research Group (UKCIRG). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The study was funded by the Special Trustees of the Hospital for Tropical Diseases, London, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Guy Thwaites and Heiman Wertheim are funded by the Wellcome Trust, UK. Jonathan Edgeworth receives funding from the Department of Health via the NIHR comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London. Sarah Walker is funded by the UK MRC and the NIHR Oxford BioMedical Research Centre. Peter Wilson is part funded by the UCLH/UCL Comprehensive Biomedical Centre which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme. Competing Interests: The authors have declared that no competing interests exist. * E-mail: guy.thwaites@btinternet.com " Membership of the writing committee and the United Kingdom Clinical Infection Research Group (UKCIRG) is provided in the Acknowledgments.