Staphylococcus aureus bacteremia: Difference between revisions

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Staphylococcus aureus bacteremia
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= Classification =
== Classification ==


* '''Community-onset:''' positive blood culture obtained within 48 hours of presentation
* '''Community-onset:''' positive blood culture obtained within 48 hours of presentation
* '''Nosocomial:''' positive blood culture obtained after 48 hours of presentation
* '''Nosocomial:''' positive blood culture obtained after 48 hours of presentation


= Etiology =
== Etiology ==


* IVDU
* IVDU
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* Dental work
* Dental work


= Clinical Presentation =
== Clinical Presentation ==


* Often non-specific fevers and chills, diagnosed on blood cultures
* Often non-specific fevers and chills, diagnosed on blood cultures
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* May present with focus of metastatic disease
* May present with focus of metastatic disease


= Investigations =
== Investigations ==


= Management =
== Management ==


* Infectious diseases consultation
* Infectious diseases consultation
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** Target trough 15-20
** Target trough 15-20


= Prognosis =
== Prognosis ==


* Mortality 20-50% at 30 days, 60% at 1 year
* Mortality 20-50% at 30 days, 60% at 1 year
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** Institutionalized patient
** Institutionalized patient


= Further Reading =
== Further Reading ==


{{DISPLAYTITLE:''Staphylococcus aureus'' bacteremia}}
{{DISPLAYTITLE:''Staphylococcus aureus'' bacteremia}}

Revision as of 15:28, 17 August 2019

Classification

  • Community-onset: positive blood culture obtained within 48 hours of presentation
  • Nosocomial: positive blood culture obtained after 48 hours of presentation

Etiology

  • IVDU
  • Poor dentition
  • Dental work

Clinical Presentation

  • Often non-specific fevers and chills, diagnosed on blood cultures
  • May have back pain unrelated to spinal osteomyelitis
  • May present with focus of metastatic disease

Investigations

Management

  • Infectious diseases consultation
  • Must rule out endocarditis! TTE, followed by TEE if suspicion remains high
  • Low risk for endocarditis (no TEE) if all of the following:
    • No intracardiac device
    • Sterile follow-up blood cultures within 4 days from the initial set
    • No hemodialysis
    • Nosocomial acquisition of S. aureus
    • Absence of secondary foci
    • No clinical signs of endocarditis
  • Uncomplicated if
    • Endocarditis is excluded
    • No implanted prostheses
    • Blood cultures clear by 2-4 days
    • Defervesces within 72 hours
    • No evidence of metastases
    • +/- identified source has been removed
  • Two-week course acceptable if uncomplicated, otherwise 4-6 weeks
  • MSSA: cloxacillin 2g IV q4h for 2 weeks (cefazolin as an alternative)
  • MRSA: vancomycin 1g IV q12h for 2 weeks
    • Adjust based on serum trough before every fourth dose
    • Target trough 15-20

Prognosis

  • Mortality 20-50% at 30 days, 60% at 1 year
  • Mortality halved by ID consult
  • Prognosis worse with
    • Increased age
    • Female sex
    • Pneumonia or source unknown
    • Dementia
    • Increasing comorbidities
    • Shock at time of presentation
    • Institutionalized patient

Further Reading