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Abstract

Background:

Standard of care for management of bacteraemia (SAB) is 2-4 weeks intravenous (IV) flucloxacillin or glycopeptide. Ceftriaxone (CRO) is used to facilitate management of SAB under out-patient antimicrobial therapy (OPAT) services once patients are medically stable, however published data on this approach are limited.

Methods:

Retrospective review of SAB cases at Homerton Hospital: 1st August 2015 to 31st July 2018. Cases were identified from the microbiology database and clinical data retrospectively collected from electronic patient records.

Results:

83 cases of SAB were included. Median age was 56 years (IQR 45-74); 53 (63.9%) were male. 70 (84.3%) had complicated SAB, 4 (4.8%) had MRSA bacteraemia and 11/80 (13.8%) were PVL positive. After excluding patients who died or were transferred whilst on IV therapy; 8/11 (72.7%) uncomplicated SAB patients and 29/55 (52.7%) complicated SAB patients received the standard duration of IV anti-staphylococcal therapy. Median length of stay (LOS) was 32 days (IQR 16-52.5). 30-day mortality was 9.6%; in hospital mortality was 14.5%.

Eight (8/83, 9.6%) patients switched to CRO prior to completion of standard IV flucloxacillin therapy to facilitate OPAT. Median length of IV flucloxacillin in this group was 12 days (IQR 7-16). Ceftriaxone MIC was performed on 1/8 isolates (3mg/L). 7/8 had complicated SAB. Median LOS was 13 days (IQR 9-17). There were no deaths or relapsed infections. 1 patient developed C. difficileinfection on CRO.

Conclusion:

In this cohort ceftriaxone was a safe and effective follow-on therapy from flucloxacillin for management of SAB and allowed reduced LOS.

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/content/journal/acmi/10.1099/acmi.fis2019.po0178
2020-02-28
2020-06-04
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http://instance.metastore.ingenta.com/content/journal/acmi/10.1099/acmi.fis2019.po0178
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