Staphylococcus Aureus Bloodstream Infection (SABSI)

Other risk factors may include:

• Prolonged hospital admissions
• A weakened immune system
• Prolonged antibiotic use
• Use of injection medicines
• Older age
• Chronic diseases (e.g. diabetes, rheumatoid arthritis

(Healthdirect 2024a; Abraham & Bamberger 2020)

SABSI acquired in healthcare settings is referred to as a healthcare-associated Staphylococcus aureus bloodstream infection. SABSI acquired outside of healthcare settings is considered community-acquired.

Identifying SABSI

There are different types of symptoms that may present with SABSI, depending on the variation of the infection.

Common symptoms may include:

• Signs of infection
• Boils and/or pus-filled sores
• Red/swollen/warm skin
• Pain

Symptoms indicating a more serious infection include:

• Feeling unwell
• Confusion
• A temperature >38°C
• Uncontrollable shaking
• Shortness of breath
• Difficulty moving a joint
• Blood spots in eyes, bleeding underneath fingernails and toenails
• Sunburn-like rash

(Healthdirect 2024a; Healthdirect 2024c)

If a person is suspected of having SABSI, two sets of blood cultures should be taken immediately. The two sets of blood cultures should be aseptically taken from two different venepuncture sites and preferably not from an intravascular device. If the two results don’t match, further investigation is required.

Healthcare-Acquired Staphylococcus Aureus Bloodstream Infection

In 2020, a national target of 1.0 HA-SABSI cases per 10,000 patient days was collectively agreed upon across all Australian states and territories. For reporting purposes, Australian hospitals are required to distinguish whether an infection was healthcare-associated or community-acquired (AIHW 2026).

A SABSI is considered to be healthcare-associated (HA-SABSI) if either:

• An initial positive blood culture is taken more than 48 hours after admission (with no evidence the infection was present upon admission) or within 48 hours after discharge, OR
• An initial positive blood culture is taken 48 hours or less after admission, AND:
• The infection is the result of an invasive device complication, or
• The infection occurred within 30 days of a surgical procedure and is related to the surgical site (90 days for deep incisional/organ space infections related to a surgically implanted device), or
• The infection was diagnosed within 48 hours of an invasive instrumentation or incision that is related to the infection, or
• The infection is related to neutropenia contributed to by cytotoxic therapy.

(ACSQHC 2021)

Methicillin-resistant Staphylococcus Aureus (MRSA) Infection

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that, over time, has developed resistance to certain antibiotics (e.g. vancomycin, penicillin, etc.), making it more difficult to treat. It can present as either HA-SABSI or CA-SABSI, and is associated with poorer patient outcomes (AIHW 2026).

The rise of MRSA and antimicrobial resistance (AMR) has significantly increased morbidity, mortality, and healthcare costs worldwide. In response, hospitals in Australia are required to implement antimicrobial stewardship programs. These programs aim to guide evidence-based decisions on antimicrobial selection, dosing, and duration to improve clinical outcomes and patient safety (ACSQHC 2023).

Prevention

Hand hygiene is vital for preventing S. aureus infections. All healthcare professionals and workers must adhere to the 5 Moments for Hand Hygiene (DoH Victoria 2023).

Other prevention strategies, particularly in healthcare settings, include:

• Adhering to aseptic technique, particularly during procedures
• Utilising the correct personal protective equipment (PPE)
• Where possible, designating a single room and non-critical equipment (e.g. stethoscope) to the patient
• Storing the patient’s charts outside of the room
• Ensuring any wounds or lesions are covered and discharge is contained
• Ensuring linen, belongings and equipment are cleaned or disposed of as per the organisation’s policies
• Encouraging patients and visitors to engage in hand hygiene.

(SA Health 2025)

Treatment

SABSI is typically treated with at least 14 days of intravenous antibiotics, though more severe or complicated cases may need up to 6 weeks of IV therapy. An infectious diseases physician will guide the treatment plan, which differs depending on patient factors and the specific strain or infection.

For example, osteomyelitis caused by S. aureus could require several months of oral antibiotics. Ongoing patient review and monitoring are required to evaluate the effectiveness of the treatment plan (SA Health 2023). Verbal and written guidance should be provided to the patient and their family regarding relapse symptoms and that urgent review is required if they occur (Therapeutic Guidelines 2025).