S. aureus Bacteremia
Empiric Therapy

Empiric Therapy

Empiric Therapy

25mg/kg IV LOAD, then maintenance dose based on CrCl (see vancomycin monitoring) (target trough = 15-20mg/L)

OR

  • Some experts recommend doses up to 8-10mg/kg/dose for complicated MRSA bacteremia, 6mg/kg for uncomplicated bacteremia
  • For anaphylactic vancomycin allergy

PLUS EITHER (OPTIONAL)

OR

May give if non-anaphylactic penicillin allergy

  • There are data that suggest empiric treatment with dual agents to target MRSA and MSSA lead to better outcomes
  • One retrospective study did not see any difference in 30-day mortality for monotherapy with vancomycin vs. beta-lactam

Duration of Therapy

  • When calculating the duration of antimicrobial therapy day 1 of therapy is the day where a documented negative blood culture is obtained

  • Note: A single blood culture may not be sufficient to demonstrate resolution of bacteremia (typically 2 blood cultures are to be collected and both are negative)

Uncomplicated Bacteremia: Minimum of 14 days of therapy from first negative culture

Complicated Bacteremia: Minimum 28 days (4-6 weeks) from first negative culture, and tailor duration according to focus of infection and clinical progression

Additional Information

  • IV treatment is required for the entire duration of treatment for S. aureus bacteremia
  • IV therapy may be administered on an outpatient basis
  • Addition of gentamicin or rifampin to vancomycin is not routinely recommended for S. aureus bacteremia
  • While some other antibiotics may cover S. aureus they are NOT sufficient for treatment of a bacteremia:
    • Piperacillin-tazobactam
    • Clindamycin
    • Linezolid