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Treatment for golden staph is set to undergo a radical shake-up following landmark research that found a commonly used antibiotic carries a lower survival rate and elevated risk of severe side effects.
In a world-first clinical trial, an international team of researchers led by the Doherty Institute in Melbourne found the standard frontline antibiotic used for decades should no longer be the default treatment to fight the bug which kills more than 1000 Australians every year.
The trial, which monitored patients across more than 150 hospitals in 14 countries, including Australia, the United States and the United Kingdom, showed that two existing alternative antibiotics are equally effective at curing the potentially deadly infection, and also significantly safer for patients.
As part of the research, patients across the world admitted to hospital with golden staph bloodstream infections were randomly assigned to receive either the traditional treatment of flucloxacillin antibiotic or one of two alternatives.
In two separate studies, researchers then tracked these patients over 90 days to compare survival rates, side effects, and impacts on major organs.
In the first study, they found that 20 per cent of patients treated with flucloxacillin suffered acute kidney damage, compared with only 14 per cent of those treated with its substitute, cefazolin.
Patients who took cefazolin also had a better chance of survival, with 15 per cent dying within 90 days compared to 17 per cent of those who received flucloxacillin.
Meanwhile, in the second study, patients treated with another alternative antibiotic, benzylpenicillin, experienced even better survival rates, with 14 per cent dying within 90 days compared with 22 per cent in the flucloxacillin patient group.
Researchers said the findings, which have been published in prestigious scientific journals The Lancet and the New England Journal of Medicine, provided important new evidence that would guide treatment across the world.
Professor Steven Tong, an infectious diseases physician at the Doherty Institute and global co-lead investigator of the cefazolin research paper, said the findings had already changed the way he treated patients with Staphylococcus aureus bacteraemia, commonly known as golden staph.
At the Royal Melbourne Hospital, where Tong works, there are two cases of serious golden staph bloodstream infections every week.
“This has very much become our bread and butter because we see it all the time,” Tong said.
“I reflected what most Australian infectious disease physicians used to do, which was to use flucloxacillin in most cases, but now I have completely switched.”
Tong said what shocked him most was that not only did cefazolin cause fewer side effects, but the mortality rates were lower, too.
“In addition to being less toxic, it has also been shown to save more lives,” he said. “To actually see that people were less likely to die when they got cefazolin surprised all of us.”
Caitlin Alsop almost died after she contracted a severe, rapidly spreading bacterial infection that originated from an infected wisdom tooth.
The rare condition is known as Ludwig’s angina, and golden staph is one of the most common bacterial causes of it.
She developed sepsis, which progressed to septic shock, causing a drop in blood pressure and widespread organ failure.
Alsop, who lives on the Gold Coast, was in a coma for nine days in an intensive care unit.
The 31-year-old said her tongue turned black, and she almost had to have it amputated.
“The scariest part was that I initially had no symptoms,” she said.
Alsop welcomed the research findings and said getting treatment right was critical.
“It’s a medical emergency, so it’s about identifying what is the most effective and safest antibiotics for the patient to then improve their outcomes and ultimately save more lives,” she said.
Golden staph infections cause over 1 million deaths a year across the world.
In Australia, about 4000 patients are infected each year, including about 450 children, who get the most serious form of golden staph, which occurs when the infection penetrates the body’s defences and enters the bloodstream.
“When this happens, and it enters the bloodstream, about 15 to 25 per cent of patients will die,” Tong said.
“So it is a very, very high mortality rate.”
About one-third of the population harmlessly carries golden staph inside their noses.
Most of the time, the bug causes nothing more than minor skin irritation, such as boils or cellulitis, which are easily cleared up with a standard course of antibiotics.
However, Tong warned that the danger escalated dramatically when the bacteria entered the bloodstream.
In the most severe cases, the bug can quickly spread throughout the entire body, leading to life-threatening complications, including sepsis, bone infections and in rare cases, it can infect heart valves.
Infectious diseases expert Robert Booy, who was not part of the research, said the clinical trial would help shape treatment options, and he hoped it would also enhance outcomes for patients.
“Cefazolin and benzylpenicillin are already widely used antibiotics, so this is a very good thing,” he said.
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Melissa Cunningham is a health reporter for The Age. She has previously covered crime and justice.Connect via X or email.From our partners
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