Haemodialysis-dependent patients have high rates of Staphylococcus aureus bacteraemia. Clinical outcomes in these patients are not clearly defined.

We retrospectively reviewed the background and outcomes of patients with vascath-related S.aureus bacteraemia at Concord Hospital, between January 2000 and May 2006. There were 54 episodes, a majority (78%) involved internal jugular lines. The median age was 67.5 years (36 – 91years). MRSA caused bacteraemia in 31 patients (57%); phenotypically 74% were HA-MRSA (hospital acquired MRSA) and 23% EMRSA-15. In 31 (57%) patients, bacteraemia was hospital acquired, in equal numbers for MRSA and MSSA. There was a median of 17 days (range 4 -74 days) from admission to blood culture positivity.

At presentation, antibiotic therapy was delayed or inappropriate in 10 (18.5%) patients, of whom 8 were MRSA. Significant complications occurred in 9/54 (17%); 4/31 (13%) with MRSA and 5/23 (22%) with MSSA. These included endocarditis, pacemaker infection, aortic graft infection, aortic thrombus, septic thrombophlebitis, septic arthritis, osteomyelitis, and epidural abscess. All MRSA patients received vancomycin based therapy. Of the MSSA patients, 21/23 received intravenous β-lactams, 1 of 2 patients who received vancomycin was based on allergy. The mortality rate in MRSA patients was 9.7% and 16.1%, at 7 and 30 days respectively, in the MSSA group the mortality was 4.3% at 7 and at 30 days. In the 10 patients who received delayed appropriate therapy, mortality was 2 (20%) and 4 (40%), at 7 and 30 days respectively.

Patients with vascath-related S.aureus bacteraemia have high complication rates. There were higher mortality rates in vancomycin treated MRSA patients. Reassuringly, MSSA patients were consistently treated with β-lactam agents.