Staphylococcus aureus Bacteremia: Reviewing Management Strategies
the MPR take:
All adult patients with Staphylococcus aureus bacteremia are advised to undergo echocardiography, with vancomycin and daptomycin recommended as first-line antibiotics for methicillin-resistant S aureus (MRSA) bacteremia, according to a new review in the Journal of the American Medical Association. After analyzing nine studies of a total of 4,050 patients, the authors came to the following conclusions:
- Unless the patient meets the criteria for being at low risk, all patients with Staphylococcus aureus bacteremia should be evaluated with echocardiography, preferably by transesophageal echocardiography.
- Transthoracic echocardiography is adequate for low-risk patients.
- The following criteria should be met in defining low-risk patients: (1) nosocomial acquisition of bacteremia, (2) sterile follow-up blood cultures within 4 days after the initial positive blood culture, (3) no permanent intracardiac device, (4) nohemodialysis dependence, and (5) no clinical signs of endocarditis or secondary foci of infection.
- Vancomycin and daptomycin should be first-line antibiotic therapies for MRSA bacteremia.
- In patients with uncomplicated MRSA bacteremia, at least 14 days of antibiotic therapy from the first negative culture may be adequate. For all others, a longer course (eg, 4–6 weeks) is recommended.
The authors note that the evidence for most management strategies in S aureus bacteremia are poor and that high-quality trials comparing treatment strategies, antibiotics, and duration of therapies are necessary for improved management of this infection.
Importance: Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia. Objectives: To review evidence of management strategies for S aureus bacteremia to determine whether transesophageal echocardiography is necessary in all adult cases and what is the ...
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