Guidelines
Staphylococcus aureus Bacteremia

Staphylococcus aureus Bacteremia

Background

URGENT Infectious Disease consultation strongly recommended:

  • Associated with improved patient outcomes and decreased mortality.

URGENT treatment and source control are essential:

  • Never consider S. aureus bacteremia to be secondary to contamination (even if only 1 positive blood culture).
  • Staphylococcus aureus bacteremia is associated with significant patient morbidity and mortality (mortality rate 10 – 30%).
  • Staphylococcus aureus can spread from the blood and cause metastatic foci of infection in nearly any organ system including the brain, eye, bone/joint, lung, intraabdominal cavity, liver, spleen, artery/endothelium, endocarditis etc.
  • Staphylococcus aureus bacteriuria may be an indicator of a S. aureus bacteremia – recommend obtaining blood cultures and clinically evaluate for a systemic Staphylococcal infection.

Most Common Organisms

  • History of MRSA infection or colonization
  • Household contact with a MRSA colonized individual
  • IV drug use
  • Homelessness
  • Incarcerated persons
  • Recent travel to or residing in an MRSA endemic region or community

Management & Work-Up

  • Thorough physical examination and careful history required to determine the potential source of infection and possible metastatic foci.
  • Diagnostic imaging should be tailored to the findings from history and physical examination (ex: acute onset lumbar spine pain should prompt an MRI lumbar spine).
  • Indwelling prosthetic devices (e.g. cardiac device, orthopedic hardware, central lines, etc.) should be identified and carefully evaluated for infection.
  • Transthoracic echocardiogram recommended in all patients with Staphylococcus aureus bacteremia to rule out endocarditis.
    • Transesophageal echocardiogram preferred in those at high risk: embolic events, pacemaker, prosthetic valve, previous infective endocarditis, or intravenous drug use.
    • Consult infectious diseases for recommendations.
  • Remove the focus of infection if possible (e.g. catheter-associated bacteremia; drainable abscess, etc.).

    • New central lines should NOT be inserted, unless necessary for IV access, until there is documented clearance of the bacteremia.
  • Repeat blood cultures every 48 hours after until negative to document sterilization and determine duration of therapy.

  • Persistent bacteremia after initiation of appropriate antimicrobial therapy warrants careful reassessment and suggests inadequate source control or presence of an endovascular infection.

Empiric Treatment

Complicating factors include:

  • severe infection;
  • suspected endocarditis;
  • prosthetic or intravascular device infection; OR
  • presence of MRSA risk factors.

More Information

Content derived from: NB Provincial Health Authorities Anti-Infective Stewardship Committee. Management of Staphylococcus aureus Bacteremia. 2021-02.

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