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Urine culture growing Staphylococcus aureus

S Holmes, 43 Y, M

Clinical details: Dipstick positive for blood

Antibiotic: None; Allergy: None

Sample for GP surgery (community)

Sample Catheter urine

Growing Staphylococcus aureus

Sensitive to cefoxitin/oxacillin, nitrofurantoin, trimethoprim, amikacin, gentamicin, ciprofloxacin, erythromycin, clindamycin, tetracycline, vancomycin, teicoplanin, linezolid, daptomycin. Resistant to penicillin.

Question:

Write interpretative comment(s).
Which antibiotics would you release, if any, and why? (expect a discussion here about the merit of releasing antibiotics and effective antibiotics)

Several points need to be considered here.

1. Clinical details did not mention any clinical signs/symptoms suggestive of UTI.

2. Clinical details mention urine dipstick was positive and the decision may have made based on that information (often it might not be the case as the urine could have been sent by a nurse or health care worker, who may not have understood the importance of clinical details, but you have to consider what information have been provided to you). How useful is urine dipstick in diagnosing UTI in a catheterised patient?

3. The catheter may get colonised with bacteria very quickly (a day or two). 

4. Staph aureus in the urine could be a colonising flora or may represent a systemic infection.

5. Whether you would like to release sensitivity on this one. Many trusts have a policy of not to release antibiotic for a catheter urine sample. A pragmatic approach may be to only release sensitivity when the clinical details clearly suggest a UTI.

6. You may want to consider what antibiotic will be appropriate, if you decide to release any - Nitrofurantoin, trimethoprim, coamoxiclav, flucloxacillin, etc.

7. You may want to put a comment about changing catheter if it is necessary e.g. a long term catheter.