Background Staphylococcus aureus bacteraemia (SAB) is associated with high mortality and morbidity. Certain patient groups are predisposed to developing SAB. Careful monitoring of these patients for persistence of bacteraemia and development of complications is important to improve prognosis. There is international consensus on (i) treating patients with at least 2 weeks of IV antibiotics, (ii) performing echocardiography to evaluate for infective endocarditis and (iii) repeating blood cultures 2–4 days after initiating empirical treatment. Adherence to trust antimicrobial guidelines is also imperative to national antimicrobial stewardship. Objectives To characterize patients at risk of SAB and make recommendations to reduce the incidence and complications of SAB. Methods Retrospective review of case notes of patients whose blood culture results were positive for S. aureus from April to September 2022 in NWAFT. 57 results from 51 patients aged 0 to 96 years were included. The four audit standards were compliance with (i) trust empirical antimicrobial guidelines, (ii) 2-week duration of IV therapy, (iii) echocardiography evaluation for endocarditis, and (iv) repeat blood cultures 48–96 hours after initiating empirical treatment. Patients who were on palliative pathway were excluded from analysis of standards two to four. Prognostic outcomes were examined in terms of hospital readmission, recurrence and mortality. Results 36 patients (70.6%) were found to harbour known risk factors, with the presence of indwelling prosthetic devices (83.3%) and type 2 diabetes (25.0%) being the most common. The most frequent sources of infection were unknown (27.5%) as well as the skin or soft tissue (17.6%). MRSA bacteraemia accounted for 10.5% of all cases. The compliances with (i) trust empirical antimicrobial guidelines, (ii) 2-week duration of IV therapy, (iii) echocardiography evaluation of endocarditis and (iv) repeat blood cultures 48–96 hours after initial blood culture were 52.8%, 75.0%, 57.8% and 66.0%, respectively. Rates of hospital readmission, recurrence and mortality were 39.5%, 11.4% and 35.3%, respectively. Conclusions The incidence of SAB correlates with the presence of risk factors, and SAB is associated with adverse outcomes. There was partial compliance with the audited outcomes. Introduction of trust SAB guidelines to guide clinical approach and adherence to local antimicrobial prescribing guidelines are imperative to improving patient outcomes.

Objective: Knee joint trauma can cause an osteochondral defect (OD), a risk factor for osteoarthritis and cause of debilitating pain in patients. Modelling OD in rodents is difficult due to their smaller joint size. This study proposes sheep as a translationally relevant model to understand the neuronal basis of OD pain. Methods: Unilateral 6 mm deep OD was induced in adult sheep, 2-6 weeks after which dorsal root ganglion neurons (DRG neurons) were cultured from the control and OD side. Functional assessment of neuronal excitability and activity of the pain-related ion channels, TRPV1 and P2X3, was carried out using electrophysiology and Ca2+-imaging. Immunohistochemistry was utilized to verify expression of pain-related proteins. Results: An increased proportion of OD DRG neurons (sheep, n = 3, Ctrl neurons, n =15, OD neurons, n = 16) showed spontaneous electrical excitability (p = 0.009, unpaired t-test) and hyperexcitability upon TRPV1 agonist (capsaicin) application (p = 0.04, chi-sq test). Capsaicin also produced Ca2+ influx in an increased proportion of OD DRG neurons isolated (p = 0.001, chi-sq test). By contrast, neither protein expression, nor functionality of the P2X3 ion channel were altered in OD neurons. Conclusions: We provide evidence of increased excitability of DRG neurons (which is an important neural correlate of pain) and TRPV1 function in an OD sheep model. Our data show that functional assessment of sheep DRG neurons can provide important insights into the neural basis of OD pain and thus potentially prevent its progression into arthritic pain.