Staphylococcus aureus Bacteremia
- Associated with improved patient outcomes and decreased mortality.
- 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
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.
Complicating factors include:
prosthetic or intravascular device infection; OR
presence of MRSA risk factors.
Content derived from: NB Provincial Health Authorities Anti-Infective Stewardship Committee. Management of Staphylococcus aureus Bacteremia. 2021-02.
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