Vancomycin (Dosing per pharmacy)
Oxacillin 12g/24h if susceptible.
Preferred to vancomycin
Cefazolin 2g IV q8h
(Non-anaphylactic PCN allergy)
14 days is the minimum duration of therapy for S. aureus bacteremia and should only be considered if endocarditis or other metastatic infection have been ruled out.
Treatment must be parenteral. Oral antibiotics are not appropriate for S. aureus bloodstream infections.
Infectious Diseases consult is strongly advised for all patients with S. aureus bloodstream infection to ensure optimal therapy
A thorough search for metastatic sites of infection should be considered in all patients with S. aureus bloodstream infection
Remove central lines. Relapse rates are unacceptably high with line retention.
Vancomycin is inferior to oxacillin or cefazolin for treatment of MSSA. Do not choose vancomycin solely due to convenience of dosing (e.g. in hemodialysis patients).
All patients with S. aureus bacteremia should have an echocardiogram to rule out endocarditis. Clinical suspicion and physical exam findings do not correlate with echocardiographic findings of endocarditis in S. aureus bacteremia (Fowler JACC 1997)
Transthoracic echo (TTE) is acceptable ONLY if the study can adequately view the leftsided valves; most experts recommend transesophageal echo (TEE) in patients with S. aureus bacteremia.
“Valve thickening, cannot rule out endocarditis” should not be interpreted as meeting Duke criteria for a vegetation. Such patients should not receive treatment for endocarditis without other compelling evidence.
Linezolid should not be used to treat S. aureus bacteremia as monotherapy.