Dr. Andrew Simms, MD

S. aureus Bacteremia Management

Microbiology and Epidemiology

·         S. aureus is a gram-positive cocci that is ubiquitous and part of normal human skin flora

·         Colonizes in the nares, 30-40% of general population colonized. Higher in hospitalized population

·         Can affect essentially any organ system, has a propensity for indwelling and prosthetic devices

·         Certain populations are at increased risk of developing bacteremia:

o   Indwelling prosthetic devices

o   HD dependent

o   IVDU

o   Nasal colonization

o   Males > Females (~1.5x more likely)

o   Diabetics

o   Immunocompromised, HIV, Cancer

·         S. aureus bacteremia is associated with significant morbidity and mortality, estimated 20-40%

Classification and Evaluation

·         Uncomplicated (Must meet ALL 5 criteria)

o   Endocarditis ruled out by TTE / TEE

o   No indwelling devices present

o   Follow-up cultures negative <96 hours after initial culture and foci removal

o   Afebrile within 72 hours of first positive culture

o   No evidence of metastatic infection (Back pain, joint pain, neuro symptoms, etc.)

·         Complicated (Anything that does not satisfy all of above criteria)

·         First, assess for possible source. Is there an indwelling device? Skin breakdown? Soft tissue infection or abscess?

·         Second, assess for signs of metastatic infection. Are there symptoms compatible with this such as back pain? Joint pain or ROM limitation? Neurological symptoms? Abdominal pain?

·         Third, assess for signs of endocarditis. Are there any Osler’s nodes? Janeway lesions? Roth spots? Splinter hemorrhages?

·         ALL patients need a TTE at minimum (60-70%) sensitivity

·         Can consider skipping TEE (>95% sensitivity) if ALL of the following conditions are met:

o   No signs of metastatic infection

o   No clinical signs of endocarditis

o   Sterile follow up cultures within 96 hours

o   No permanent intracardiac device

o   No hemodialysis dependence

o   Removeable focus removed promptly

o   Afebrile within 72 hours of initial positive culture

Dr. Bauer – Peripheral Nephropathy