Staphylococcus epidermidis is a ubiquitous biofilm producing coloniser of the skin and mucous membranes of humans. It is one of the chief causes of nosocomial infections contributing to the considerable increase in global health care costs. The proximity of skin flora to intravascular devices provides opportunity for these organisms to enter the bloodstream and cause bacteraemia. Although the isolation of S. epidermidis from patient blood cultures may signify bacteraemia, it may also indicate

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... ntamination of the blood culture bottles during initial blood collection. Due to the indolent nature of S. epidermidis bacteraemia, it is difficult to distinguish bacteraemia from blood culture contamination in patients with indwelling medical devices. viii | P a g e 6.5 Discussion 160 6.6 Conclusions and future directions 175 6.7 Major outcomes of chapter 6 179 Chapter 7: Summary of findings and future directions 181 7.1 Review of hypothesis and aims 181 7.2 Summary of findings 182 7.3 Major outcomes and significance of findings 184 7.4 Limitations 187 7.5 Future directions 189 7.6 Publication strategy 191 7.6.1 Manuscripts in draft 191 7.6.2 Future manuscripts 191 Bibliography 192 ix | P a g e Supplementary appendices (electronic file) Appendix 5.1: SNP PCR runs (from research laboratory notebook) Appendix 5.2: SNP profiles of study isolates using the PCR-based minimum SNP scheme Appendix 5.3: SNP profiles for study isolates and global STs Appendix 5.4: SNP validation (from research laboratory notebook) Appendix 5.5: Virulence factor PCR runs (from research laboratory notebook) Appendix 6.1: Whole genome sequence assembly data Appendix 6.2: SNP type using WGS data Appendix 6.3: List of SNP profiles for local hospital and global STs xiv | P a g e