Take this quick medical pop quiz: which of the following conditions would you prefer to have during your next stay in hospital? A. Staphylococcus aureus (golden staph) bloodstream infection; or B. a heart attack?
I am guessing most non-medical readers voted for the Staph option and, if my experience is anything to go by, the majority of medical readers will have also made a microbial choice.
The disturbing truth is that a Staph aureus bloodstream infection has a 12-month death rate of between 20 and 35%, compared with 3-5% for a heart attack in hospital. Although antibiotic-resistant Staph aureus (MRSA) infections carry a slightly higher death rate, even the drug-sensitive Staphs are among the most potent of pathogens.
Staph aureus lives on our skin and in our nose where it usually causes no harm. But if we are admitted to hospital and have an intravenous catheter inserted through our skin, the Staph aureus can be carried on the tip of the needle into the vein.
Usually our immune system mops up any stray microbes but the reason for coming to the hospital in the first place may have weakened our defences. Infections such as pneumonia, the effects of cancer and its treatment, diabetes, drugs that suppress the immune system and surgery make us more vulnerable to hospital-acquired infections.
Very sick patients often require long-term intravenous access through central venous catheters (which are inserted into a large vein at the chest, neck or groin). These carry a higher risk of infection than small peripheral cannulas, usually inserted in veins of the hand or arm.
Patients with bloodstream infections develop chills, fever, headache, muscle and back pain and may go on to develop failure of one or more organ systems.
The complications of Staph aureus bloodstream infections (which, going back to our quiz, include a heart attack) may take weeks or months to develop; by the time the patients who survive have been discharged from the intensive care unit, the original infection may have been forgotten.
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Today the National Health Performance Authority released its report on health care associated Staph aureus bloodstream infections in Australia in 2013-14. This is the third year the data has been reported nationally and the news is mildly encouraging. In 2013-14, there were 1,621 bloodstream infections caused by Staph aureus, which is 100 fewer than in 2012-13.
Nearly 90% of the infections occurred in the 115 major and large Australian public hospitals. To make sensible comparisons, hospitals are grouped by their size and the complexity of the patients they treat. Patients with burns, cancer, HIV and those who have undergone surgery are considered to be more vulnerable to infection.
For the 36 major Australian hospitals with more vulnerable patients, the average rate of infection was 1.28 per 10,000 patient bed days, although the rate was more than three time higher in some of these hospitals than in others. At the 40 major hospitals with fewer vulnerable patients, the average rate was 0.78 per 10,000 patient days.
The agreed national benchmark is less than 2.0 per 10,000 patient days and only a handful of hospitals exceeded this rate.