【柳叶刀】Clinical management of Staphylococcus aureus bacteraemia

蓝鱼o_0

Guy E Thwaites, Jonathan D Edgeworth, Eff rossyni Gkrania-Klotsas, Andrew Kirby, Robert Tilley, M Estée Török, Sarah Walker,
Heiman F L Wertheim, Peter Wilson, Martin J Llewelyn, for the UK Clinical Infection Research Group*
Staphylococcus aureus bacteraemia is one of the most common serious bacterial infections worldwide. In the UK
alone, around 12 500 cases each year are reported, with an associated mortality of about 30%, yet the evidence guiding
optimum management is poor. To date, fewer than 1500 patients with S aureus bacteraemia have been recruited to
16 controlled trials of antimicrobial therapy. Consequently, clinical practice is driven by the results of observational
studies and anecdote. Here, we propose and review ten unanswered clinical questions commonly posed by those
managing S aureus bacteraemia. Our fi ndings defi ne the major areas of uncertainty in the management of S aureus
bacteraemia and highlight just two key principles. First, all infective foci must be identifi ed and removed as soon as
possible. Second, long-term antimicrobial therapy is required for those with persistent bacteraemia or a deep,
irremovable focus. Beyond this, the best drugs, dose, mode of delivery, and duration of therapy are uncertain, a
situation compounded by emerging S aureus strains that are resistant to old and new antibiotics. We discuss the
consequences on clinical practice, and how these fi ndings defi ne the agenda for future clinical research.

Lancet Infect Dis 2011;
11: 208–22
*Members listed at end of paper
Centre for Molecular
Microbiology and Infection,
Imperial College, London, UK
(G E Thwaites PhD); Directorate
of Infection, Guy’s and
St Thomas’s NHS Foundation
Trust, London, and
Department of Infectious
Diseases, King’s College London
School of Medicine at Guy’s,
King’s College, and St Thomas’
Hospitals, London, UK
(J D Edgeworth PhD);
Department of Infectious
Diseases, Addenbrooke’s
Hospital, Cambridge, UK
(E Gkrania-Klotsas FRCP,
M E Török FRCP); Medical
Research Council Epidemiology
Unit, University of Cambridge,
Cambridge, UK
(E Gkrania-Klotsas); Institute of
Infection and Global Health,
University of Liverpool,
Liverpool, UK (A Kirby MBChB);

Department of Microbiology,
Royal Devon and Exeter
Hospital, Exeter, UK
(R Tilley MBChB); Medical
Research Unit Clinical Trials
Unit, London, and National
Institute for Healthcare
Research Oxford Biomedical
Research Centre, Oxford, UK
(S Walker PhD); Oxford
University Clinical Research
Unit, Wellcome Trust Major
Overseas Program, Vietnam,
and Centre for Tropical
Medicine, Nuffi eld Department
of Clinical Medicine, University
of Oxford, Oxford, UK
(H F L Wertheim PhD);
Department of Microbiology,
University College London
Hospital, London, UK
(P Wilson FRCPath); and
Department of Infectious
Diseases and Microbioloy,
Brighton and Sussex Medical
School, Brighton, UK
(M J Llewelyn PhD)
Correspondence to:
Dr Guy Thwaites, Centre for
Molecular Microbiology and
Infection, Imperial College, South
Kensington Campus, Exhibition