Grant: Project Grant

Staphylococcus aureus bloodstream infection (bacteremia) is a major public health problem and one of the most common and deadly bacterial infections in the world. There are over 15,000 episodes per year in Canada, resulting in more than 3,500 deaths with an estimated treatment cost exceeding $120,000,000. Despite the high morbidity and mortality of S. aureus bacteremia, there are no international guidelines for its treatment. Despite being such a common disease, to date, there have been only five high quality randomized controlled trials involving fewer than 3,000 patients for a disease which kills an estimated 22,000 per year in the United States and Canada alone. Therefore there remains considerable uncertainty as to the best choice of antibiotics to fight this infection, providing an excellent opportunity to improve the current standard of care We will address three crucial questions surrounding treatment that will allow us to study every combination of subtypes of S. aureus bacteremia in Canada. Firstly, we will compare the antibiotics penicillin vs. cloxacillin for penicillin-susceptible S. aureus. Secondly, we will determine if cefazolin or cloxacillin should be preferred for methicillin-susceptible strains of S. aureus. Finally, we will determine if the addition of cefazolin to vancomycin improves outcomes for patients with methicillin-resistant S. aureus. We propose a pragmatic clinical trial embedded within the current standard of care for S. aureus bacteremia. Our Canadian team will be key partners in an international collaboration which revolutionizes our capacity to study this infection. By refining the optimal treatments for all types of S. aureus bacteremia, our team will help establish best practices to be deployed worldwide. Since this intervention requires no new technology, any findings from our research program will offer immediate benefits to all patients and the Canadian healthcare system.