Abstract
Keywords
- •Staphylococcus aureus is responsible for a diverse burden of human diseases.
- •S. aureus bacteremia is common, and has fatality rates approximating 25%.
- •S. aureus’ affinity for foreign material and antimicrobial resistance renders S. aureus bacteremia treatment challenging.
- •In patients with S. aureus bacteremia, the following interventions should be undertaken: 1) appropriate anti-staphylococcal therapy, 2) screening echocardiography, 3) assessment for metastatic phenomena and source control, 4) decision on duration of antimicrobial therapy, 5) Infectious Diseases consultation.
Clinical Cases
Case 1
Case 2
Case 3
- 1.What other investigations should be considered?
- 2.What is the role of echocardiogram?
- 3.What choice, route, and duration of antibiotic(s) should be administered?
- 4.What is the role of Infectious Diseases (ID) consultation?
Epidemiology and Relevance
European Centre for Disease Prevention and Control (ECDC). Surveillance atlas of infectious diseases. Available at:https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=4. Accessed June 19, 2022.

Microbiology
Appropriate Anti-Staphylococcal Therapy
Empiric S. aureus Bacteremia Therapy
MSSA Bacteremia
MRSA Bacteremia
- Rybak MJ
- Le J
- Lodise TP
- et al.
Common or Severe Adverse Reactions | Regular Monitoring (weekly) | Considerations | |
---|---|---|---|
Cefazolin Cloxacillin, nafcillin, oxacillin | Acute interstitial nephritis Hematologic dyscrasias Rash Hypersensitivity including anaphylaxis† | CBC-diff, Cr | Hypersensitivity cross-reaction of cefazolin with other beta-lactams is rare. Consider its use even in people with documented non-anaphylactic allergy to penicillins or other cephalosporins. Cloxacillin, nafcillin, oxacillin• No renal adjustment needed• Generally requires central line access due to issues with skin irritation and risk of thrombophlebitis when using a peripheral catheter |
Vancomycin | Nephrotoxicity Neutropenia Thrombocytopenia DRESS | CBC-diff, Cr, pre-vancomycin level | Infusion reaction: resolve by decreasing rate of infusion |
Daptomycin | Myositis Eosinophilic pneumonia | CBC-diff, Cr, CK | Inhibited by pulmonary surfactant; recommend against usage in pulmonic infections |
Linezolid | Myelosuppression with ≥2 weeks of use Lactic acidosis Drug interactions | CBC-diff | No renal adjustment needed Excellent pulmonic tissue penetratio Not recommended as first-line therapy in S. aureus bacteremia |
New Developments
Screening Echocardiography and Cardiac Imaging
- Habib G
- Lancellotti P
- Antunes MJ
- et al.
- Habib G
- Lancellotti P
- Antunes MJ
- et al.
Assessment for Metastatic Phenomena and Source Control
Indication | Classification of Recommendations |
---|---|
Left-sided endocarditis | Strong |
Endocarditis induced valve dysfunction resulting in heart failure | Strong |
Endocarditis induced heart block, annular or aortic abscess, or destructive penetrative lesions | Strong |
Persistent infection (characterized as persistent bacteremia or fever ≥ 5-7 days after initiation of anti-staphylococcal antibiotics) | Strong |
Relapsing prosthetic valve endocarditis despite an appropriate antimicrobial course | Moderate |
Recurrent emboli and persistent vegetations despite appropriate antimicrobial therapy | Moderate |
Vegetations >10 mm in size with clinical evidence of embolic phenomena despite appropriate antimicrobial therapy | Weak |
Right-sided endocarditis with symptomatic severe valve dysfunction AND evidence of persistent infection | Weak |
Duration of Therapy
Infectious Diseases Consultation
Conclusion
References
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Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of Interest: The authors report no conflicts of interests or competing interests related to this manuscript.
Authorship: All authors had access to the data and a role in writing this manuscript.
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