Staphylococcus aureus bloodstream infections
Staphylococcus aureus bloodstream infection is one of the most serious bacterial infections worldwide. In the United States, there are ~120,000 episodes per year with ~20,000 deaths. In Australia, it is estimated that approximately 5,000 infections occur per year (~10-20/100,000 population) with all patients being hospitalised and requiring a minimum of two weeks intravenous antibiotics.
Despite the availability of therapy, mortality associated with S. aureus bloodstream infections remains high and is estimated to be between 15-20% (i.e. 20% of patients with S. aureus bloodstream infections will be dead within 30 days after becoming infected). To put this into context, after a diagnosis of breast cancer, the average 5 year mortality is 10% (1).
S. aureus is one of the most common causes of clinically significant paediatric bacteraemia in the post-pneumococcal vaccine era, with authors of recent studies estimating the incidence of S. aureus bacteraemia in high-income countries between 6 - 26 / 100,000 children per year (2, 3). It is also the principal reason for admission to a paediatric intensive care unit (PICU) for management of sepsis in Australia and New Zealand (ANZ) (4). In the SNAP trial we intend to collect and model data from children jointly with adult data (5). A key difference is the expected 90-day mortality in children is 2-3%, substantially less than that of adults at 15-20%.
Optimal management of S. aureus bloodstream infections is uncertain with few published studies that compare current available treatments, and combinations of treatments. Fewer than 3,000 participants combined have ever been enrolled in published randomised controlled trials for S. aureus bloodstream infection treatment.