Management of non-catheter-related bacteraemia

Abstract number: S255

Miró J.M.

Patients with Gram-positive non-catheter-related bacteraemia are at high risk of septic metastases, particularly in bones and joints (especially if prostheses are present), the epidural space, intervertebral discs and cardiac valves. The presentation of non-catheter-related bacteraemia (which includes primary bloodstream infection [BSI] and bacteraemia secondary to infections in other sites acquired either in the community or in nosocomial settings) is heterogeneous and may require diagnosis and treatment of infections in foci beyond the blood.

A dominant pathogen in both nosocomial and community-acquired bacteraemia is Staphylococcus aureus, and S. aureus bacteraemia is associated with a high frequency of complications, including infective endocarditis (IE). Mortality is significantly worse in patients with primary or secondary BSI compared with catheter-related bacteraemia and also in those infected with MRSA vs MSSA. Furthermore, inappropriate empiric treatment for patients with Gram-positive bacteraemia increases mortality risk.

Treatment guidelines for bacteraemia are primarily based on specific infection foci, such as IE and catheter-related infections. Empiric treatment for bacteraemia should take account of the likely pathogen and local susceptibility patterns, in addition to presenting symptoms, patients' general heath status and medical history (including risk factors for MDR involvement), comorbidities (e.g. renal impairment) and concomitant medications. When the infection focus is not a vascular catheter, management should also address the risk of complications, particularly related to S. aureus, and the need for some patients to receive prolonged therapy, potentially with initial hospital treatment followed by continued antimicrobial therapy post-discharge.

Daptomycin* is one of the few antibiotics with efficacy and safety in the treatment of S. aureus bacteraemia, including that associated with IE. Rapid bactericidal activity, including against biofilms and stationary phase bacteria, and the potential for outpatient treatment with the once-daily 2-minute intravenous injection, are further characteristics of daptomycin that may be useful for non-catheter-related bacteraemia.

*Daptomycin is licensed in Europe for the treatment of complicated skin and soft tissue infection (cSSTI), for S. aureus right-sided infective endocarditis (RIE) and for S. aureus bacteraemia when associated with cSSTI or RIE.