Clinical approach to Staphylococcus aureus bacteremia in adults
- Vance G Fowler, Jr, MD
Vance G Fowler, Jr, MD
- Professor of Medicine
- Duke University Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Staphylococcus aureus is a leading cause of community-acquired and hospital-acquired bacteremia. Patients with S. aureus bacteremia can develop a broad array of complications that may be difficult to recognize initially and can increase morbidity. Mortality rates of 20 to 40 percent have been described [1,2]. Mortality appears to be higher with methicillin-resistant (MRSA) compared with methicillin-sensitive S. aureus (MSSA) bacteremia [1,2].
Treatment failure (ie, death within 30 days following treatment, persistent bacteremia >10 days after initiation of appropriate therapy, or recurrence of bacteremia within 60 days of discontinuing therapy) is fairly common in patients with S. aureus bacteremia, particularly with the setting of infection due to MRSA .
Issues related to the clinical approach to S. aureus bacteremia in adults will be reviewed here. Issues related to clinical manifestations of S. aureus infection are discussed separately. The epidemiology, risk factors, and complications of S. aureus bacteremia and treatment of methicillin-resistant or vancomycin-resistant S. aureus infections are discussed separately. (See "Clinical manifestations of Staphylococcus aureus infection".)
The clinical approach to S. aureus bacteremia consists of careful history and physical examination, infectious disease consultation, and diagnostic evaluation including echocardiography and additional imaging as needed.
History and physical examination — A careful history and physical examination is essential. For circumstances in which the source of bacteremia is uncertain, patients should be questioned carefully regarding potential portals of entry including recent skin or soft tissue infection and presence of indwelling prosthetic devices (including intravascular catheters, orthopedic hardware, and cardiac devices).
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- CLINICAL APPROACH
- History and physical examination
- Infectious disease consultation
- Diagnostic evaluation
- - Echocardiography
- - Imaging
- Empiric treatment
- Methicillin-susceptible S. aureus (MSSA)
- - Synergistic aminoglycosides
- Methicillin-resistant S. aureus (MRSA)
- Follow-up cultures
- DURATION OF THERAPY
- Removable focus
- Deep focus
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS