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
